Skip to main content

Advertisement

SpringerLink
Log in

Cerebrospinal Fluid Leakage During Transsphenoidal Surgery: Postoperative External Lumbar Drainage Reduces the Risk for Meningitis

  • Published:
Pituitary Aims and scope Submit manuscript

Abstract

Postoperative meningitis is a well known complication of transsphenoidal surgery (TSS). The objective of this study was to evaluate whether postoperative external cerobrospinal fluid (CSF) drainage in case of intraoperative CSF-leakage, reduces the risk of postoperative meningitis. We retrospectively reviewed a series of 278 consecutive transsphenoidal operations. In all operations with intraoperative CSF leakage, an external lumbar drain (ELD) was inserted directly postoperatively, and removed after at least 5 days.

The incidence of postoperative meningitis was compared with that in a previously studied series of 228 consecutive transsphenoidal operations, without insertion of an ELD in cases with intraoperative CSF leakage.

In the present series, postoperative meningitis occurred in 2/278 (0.7%) operations, compared to 7/228 (3.1%) operations in the previous study period (P < 0.05). Intraoperative CSF leakage was noted in 70/278 (25.2%) operations. All these patients received an ELD immediately after surgery for at least 5 days. There were no reported complications of ELD insertion. In the present series, 1 of 70 (1.4%) patients with intraoperative CSF leakage developed meningitis, compared to 3 of 22 (13.6%) patients in the previous study (P < 0.05).

The present report on 278 consecutive transsphenoidal operations shows that the routine insertion of an ELD in patients in whom intraoperative CSF leakage is observed significantly reduces the incidence of postoperative meningitis. Possibly, diversion of CSF prevents the formation of a CSF fistula and thereby the risk of infection. The role of prophylactic antibiotic treatment in patients with CSF rhinorrhea after TSS remains to be established.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Laws ER, Jr., Thapar K. Surgical management of pituitary adenomas. Baillieres Clin Endocrinol Metab 1995;9(2):391–405.

    PubMed  Google Scholar 

  2. Cappabianca P, Cavallo LM, Mariniello G, de Divitiis O, Romero AD, de Divitiis E. Easy sellar reconstruction in endoscopic endonasal transsphenoidal surgery with polyester-silicone dural substitute and fibrin glue: Technical note. Neurosurgery 2001;49(2):473–475.

    Article  CAS  PubMed  Google Scholar 

  3. Kitano M, Taneda M. Subdural patch graft technique for watertight closure of large dural defects in extended transsphenoidal surgery. Neurosurgery 2004;54(3):653–660.

    PubMed  Google Scholar 

  4. Seiler RW, Mariani L. Sellar reconstruction with resorbable vicryl patches, gelatin foam, and fibrin glue in transsphenoidal surgery: A 10-year experience with 376 patients. J Neurosurg 2000;93(5):762–765.

    CAS  PubMed  Google Scholar 

  5. Sonnenburg RE, White D, Ewend MG, Senior B. Sellar reconstruction: Is it necessary? Am J Rhinol 2003;17(6):343–346.

    PubMed  Google Scholar 

  6. van Aken MO, de Marie S, van der Lely AJ, et al. Risk factors for meningitis after transsphenoidal surgery. Clin Infect Dis 1997;25(4):852–856.

    CAS  PubMed  Google Scholar 

  7. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections. Am J Infect Control 1988;16(3):128–140.

    Article  CAS  PubMed  Google Scholar 

  8. De P, Rees DA, Davies N, et al. Transsphenoidal surgery for acromegaly in wales: Results based on stringent criteria of remission. J Clin Endocrinol Metab 2003;88(8):3567–3572.

    Article  CAS  PubMed  Google Scholar 

  9. Abosch A, Tyrrell JB, Lamborn KR, Hannegan LT, Applebury CB, Wilson CB. Transsphenoidal microsurgery for growth hormone-secreting pituitary adenomas: Initial outcome and long-term results. J Clin Endocrinol Metab 1998;83(10):3411–3418.

    Article  CAS  PubMed  Google Scholar 

  10. Haile-Mariam T, Laws E, Tuazon CU. Gram-negative meningitis associated with transsphenoidal surgery: Case reports and review. Clin Infect Dis 1994;18(4):553–556.

    CAS  PubMed  Google Scholar 

  11. Ross DA, Wilson CB. Results of transsphenoidal microsurgery for growth hormone-secreting pituitary adenoma in a series of 214 patients. J Neurosurg 1988;68(6):854–867.

    CAS  PubMed  Google Scholar 

  12. Black PM, Zervas NT, Candia GL. Incidence and management of complications of transsphenoidal operation for pituitary adenomas. Neurosurgery 1987;20(6):920–924.

    CAS  PubMed  Google Scholar 

  13. Ciric I, Mikhael M, Stafford T, Lawson L, Garces R. Transsphenoidal microsurgery of pituitary macroadenomas with long-term follow-up results. J Neurosurg 1983;59(3):395–401.

    CAS  PubMed  Google Scholar 

  14. Kumar A, Maartens NF, Kaye AH. Reconstruction of the sellar floor using Bioglue following transsphenoidal procedures. J Clin Neurosci 2003;10(1):92–95.

    Article  PubMed  Google Scholar 

  15. Cappabianca P, Cavallo LM, Esposito F, Valente V, de Divitiis E. Sellar repair in endoscopic endonasal transsphenoidal surgery: Results of 170 cases. Neurosurgery 2002;51(6):1365–1371.

    Article  PubMed  Google Scholar 

  16. Grady RE, Horlocker TT, Brown RD, Maxson PM, Schroeder DR. Neurologic complications after placement of cerebrospinal fluid drainage catheters and needles in anesthetized patients: Implications for regional anesthesia. Mayo Perioperative Outcomes Group. Anesth Analg 1999;88(2):388-392.

    CAS  Google Scholar 

  17. Kelly DF, Oskouian RJ, Fineman I. Collagen sponge repair of small cerebrospinal fluid leaks obviates tissue grafts and cerebrospinal fluid diversion after pituitary surgery. Neurosurgery 2001;49(4):885–889.

    CAS  PubMed  Google Scholar 

  18. Casiano RR, Jassir D. Endoscopic cerebrospinal fluid rhinorrhea repair: Is a lumbar drain necessary? Otolaryngol Head Neck Surg 1999;121(6):745–750.

    Article  CAS  PubMed  Google Scholar 

  19. Coplin WM, Avellino AM, Kim DK, Winn HR, Grady MS. Bacterial meningitis associated with lumbar drains: A retrospective cohort study. J Neurol Neurosurg Psychiatry 1999;67(4):468–473.

    CAS  PubMed  Google Scholar 

  20. Acikbas SC, Akyuz M, Kazan S, Tuncer R. Complications of closed continuous lumbar drainage of cerebrospinal fluid. Acta Neurochir (Wien) 2002;144(5):475–480.

    CAS  Google Scholar 

  21. {Kitchel SH, Eismont FJ, Green BA. Closed subarachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine. J Bone Joint Surg Am 1989;71(7):984–987.

    CAS  PubMed  Google Scholar 

  22. Shapiro SA, Scully T. Closed continuous drainage of cerebrospinal fluid via a lumbar subarachnoid catheter for treatment or prevention of cranial/spinal cerebrospinal fluid fistula. Neurosurgery 1992;30(2):241–245.

    CAS  PubMed  Google Scholar 

  23. Mayhall CG, Archer NH, Lamb VA, et al. Ventriculostomy-related infections. A prospective epidemiologic study. N Engl J Med 1984;310(9):553–559.

    CAS  PubMed  Google Scholar 

  24. Lyke KE, Obasanjo OO, Williams MA, O’Brien M, Chotani R, Perl TM. Ventriculitis complicating use of intraventricular catheters in adult neurosurgical patients. Clin Infect Dis 2001;33(12):2028–2033.

    Article  CAS  PubMed  Google Scholar 

  25. Candrina R, Galli G, Rossi M, Bollati A. Tension pneumocephalus after transsphenoidal surgery for acromegaly. J Neurosurg Sci 1989;33(4):311–315.

    CAS  PubMed  Google Scholar 

  26. Sawka AM, Aniszewski JP, Young WF, Jr., Nippoldt TB, Yanez P, Ebersold MJ. Tension pneumocranium, a rare complication of transsphenoidal pituitary surgery: Mayo Clinic experience 1976–1998. J Clin Endocrinol Metab 1999;84(12):4731–4734.

    Article  CAS  PubMed  Google Scholar 

  27. Landolt AM. Trannssphenoidal surgery of pituitary tumors: Its pitfalls and complications. In Progress in Neurological Surgery. Some Pitfalls and Problems in Neurosurgery. Karger, Basel, Switzerland 1990;13,1–30.

Download references

Author information

Authors and Affiliations

  1. Section of Endocrinology, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands

    M. O. van Aken, R. A. Feelders, A. J. van der Lely, S.W.J. Lamberts & W. W. de Herder (MD PhD)

  2. Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands

    S. de Marie

  3. Department of Neurosurgery, Erasmus MC, Rotterdam, The Netherlands

    J. H. van de Berge, A.H.G. Dallenga & E. J. Delwel

  4. Department of Otorhinolaryngology-Head and Neck Surgery, Erasmus MC, Rotterdam, The Netherlands

    R.M.L. Poublon

  5. Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, The Netherlands

    J. A. Romijn

  6. Department of Internal Medicine, Section of Endocrinology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands

    W. W. de Herder (MD PhD)

Authors
  1. M. O. van Aken
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. A. Feelders
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. de Marie
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. H. van de Berge
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A.H.G. Dallenga
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E. J. Delwel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R.M.L. Poublon
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. A. Romijn
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A. J. van der Lely
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. S.W.J. Lamberts
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. W. W. de Herder
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W. W. de Herder.

Rights and permissions

Reprints and permissions

About this article

Cite this article

van Aken, M.O., Feelders, R.A., de Marie, S. et al. Cerebrospinal Fluid Leakage During Transsphenoidal Surgery: Postoperative External Lumbar Drainage Reduces the Risk for Meningitis. Pituitary 7, 89–93 (2004). https://doi.org/10.1007/s11102-005-5351-3

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11102-005-5351-3

Key Words

Search

Navigation