Incidence and risk factors of subdural hematoma after intraoperative cerebrospinal fluid leakage during the transsphenoidal approach

• Published in: Pituitary Vol. 19; no. 6; pp. 565 - 572
• Main Authors: Takeuchi, Kazuhito, Watanabe, Tadashi, Nagatani, Tetsuya, Nagata, Yuichi, Chu, Jonsu, Wakabayashi, Toshihiko
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2016; Springer Nature B.V
• Subjects: Adult; Aged; Cerebrospinal Fluid Leak - complications; Endocrinology; Female; Hematoma, Subdural - diagnostic imaging; Hematoma, Subdural - epidemiology; Hematoma, Subdural - etiology; Human Physiology; Humans; Incidence; Intraoperative Complications; Japan - epidemiology; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Neurosurgical Procedures - methods; Pituitary Neoplasms - surgery; Postoperative Complications - diagnostic imaging; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Retrospective Studies; Risk Factors; Tomography, X-Ray Computed; Craniopharyngioma; Hypopituitarism; Cerebrospinal fluid leakage; Transsphenoidal surgery; Subdural hematoma; Pituitary adenoma
• ISSN: 1386-341X; 1573-7403
• DOI: 10.1007/s11102-016-0746-x

Purpose The transsphenoidal approach (TSA) is regarded as the first line of treatment for sellar and suprasellar lesions. There are only few case reports of postoperative subdural hematoma after TSA and extended transsphenoidal approach (eTSA), and the detailed incidence and risk factors for this complication are still unknown. We reviewed the incidence and risk factors for subdural hematoma after TSA and eTSA. Methods Between January 1, 2013 and December 31, 2014, 165 consecutive patients underwent TSA or eTSA at Nagoya University Hospital and Nagoya Daini Red Cross Hospital. Fifty-one patients experienced intraoperative CSF leakage. Postoperative subdural hematoma was observed in 10 patients, all of whom experienced intraoperative CSF leakage. We reviewed clinical data including CT and MR images and examined factors related to subdural hematoma among patients with intraoperative CSF leakage. Results In univariate statistical analyses, risk factors for postoperative subdural hematoma were advanced age, high Evans’ index, and preoperative hypopituitarism. These factors were also significant in the multivariate logistic regression analysis. There were no statistical differences in sex, tumor size, approach methods, preoperative diabetes insipidus, or degree of intraoperative CSF leakage. Conclusions The incidence of postoperative subdural hematoma after intraoperative CSF leakage during TSA and eTSA was higher than the incidence reported in patients after craniotomy. Intraoperative CSF leakage should be avoided as much as possible, especially in patients with brain atrophy and/or enlargement of the ventricular system, even if the intent of the reconstruction technique is authenticity. In addition, patients with hypopituitarism should be carefully followed up after surgery.