Analysis Of Risk Factors For Cerebrospinal Fluid Leakage After Neuroendoscopic Transsphenoidal Pituitary Adenomectomy And The Role Of Intraoperative Knot Pushers In Skull Base Reconstruction

Objective(s):To construct a predictive model for postoperative cerebrospinal fluid leakage by retrospectively analyzing the risk factors for cerebrospinal fluid leakage in patients after neuroendoscopic transsphenoidal approach for pituitary adenoma resection,and to discuss the role of intraoperative knot pushers in skull base reconstruction in conjunction with independent risk factors for cerebrospinal fluid leakage.Methods:The clinical data of 112 patients who underwent neuroendoscopic transsphenoidal approach surgery for pituitary adenoma in the Department of Neurosurgery of the Second Affiliated Hospital of Kunming Medical University between January 2017 and December 2020 were retrospectively analyzed,and they were divided into two groups according to the presence or absence of postoperative cerebrospinal fluid leakage.t-test,chi-square test,Fisher’s exact probability test and multi-factor logistic regression were used to The risk factors for postoperative cerebrospinal fluid leakage were analyzed,a Nomogram prediction model was constructed,and its efficacy was verified.Results:The incidence of postoperative cerebrospinal fluid leak in this study was17.9%,and a retrospective analysis of the risk factors for its occurrence revealed a correlation between operative time greater than three hours,intraoperative saddle septal rupture,intraoperative failure to use a tipped nasal septal mucosal flap,and pterygoid sinus opening time and postoperative cerebrospinal fluid leak.The incidence of postoperative cerebrospinal fluid leakage was higher in patients with an operative time greater than three hours(31.0%)than in patients with an operative time less than or equal to three hours(10.0%);intraoperative saddle septal rupture was correlated with postoperative cerebrospinal fluid leakage(P=0.0110),and the incidence of postoperative cerebrospinal fluid leakage was higher in patients with intraoperative saddle septal rupture(P=0.0110).The incidence of cerebrospinal fluid leak was higher in patients with intraoperative septal rupture(38.9%)than in patients with unruptured septum(13.8%);the incidence of postoperative cerebrospinal fluid leak was higher in patients without intraoperative tipped nasal septal mucosal flap(31.8%)than in patients with intraoperative tipped nasal septal mucosal flap(8.8%),with a statistically significant difference(0.0218);the time of intraoperative pterygoid sinus opening was correlated with the occurrence of postoperative cerebrospinal fluid leak.The intraoperative pterygoid sinus opening time was 3.24±1.52 h in patients with postoperative cerebrospinal fluid leak,while the intraoperative pterygoid sinus opening time was 2.55±1.42 in patients without postoperative cerebrospinal fluid,with a statistically significant difference(P=0.0494).Multifactorial logistic regression analysis showed that operative time greater than three hours(OR=0.02612,95% CI:0.001321-0.1603,P=0.0011)and intraoperative saddle septal rupture(OR=7.668,95% CI:1.745-37.36,P=0.0077)were independent risk factors for postoperative cerebrospinal fluid leak,and intraoperative The use of a tipped nasal septal mucosal flap(OR=64.2,95% CI:9.603-1347,P=0.0003)was a protective factor for postoperative cerebrospinal fluid leak.The constructed Nomogram prediction model had an area under the ROC curve(AUC)of 0.90(95% CI=0.8323-0.9671,P<0.0001) and passed the Hosmer-Lemeshow goodness-of-fit test(P=0.7787>0.05),demonstrating that the model had good predictive efficacy and there was no significant difference between the predicted and true values There was no significant difference between the predicted and true values.Conclusion(s):Operative time greater than three hours and intraoperative saddle septal rupture were independent risk factors for postoperative cerebrospinal fluid leakage after neuroendoscopic transsphenoidal pituitary adenomectomy,and intraoperative use of a tipped nasal septal mucosal flap was a protective factor for postoperative cerebrospinal fluid leakage.The time of pterygoid sinus opening differed between the two groups of patients with or without postoperative cerebrospinal fluid leak,but was not an independent risk factor.Intraoperative knot pushers have a positive role in skull base reconstruction and dural suturing.