Factors Influencing Cerebrospinal Fluid Leaking following Pituitary Adenoma Transsphenoidal Surgery: A Meta-Analysis and Comprehensive Review

Abstract

Background. Surgical resection is the main method to treat pituitary adenoma. Cerebrospinal fluid leakage (CSF Leak) is the main complication after transsphenoidal surgery. The impact of postoperative CSF Leak can be predicted in advance, and preventive measures can be taken in time. Clinically, a variety of factors may affect the occurrence of postoperative CSF Leak. In this study, meta-analysis was used to investigate the risk factors of postoperative CSF Leak as a clinical reference. Methods. The databases PubMed, Medline, Embrase, Cochrane library, CNKI, and CBM were searched for all studies on the risk factors of postoperative CSF Leak. Studies were screened and finally included. The quality of the included studies was assessed by the Newcastle-Ottawa scale. We used Revman 5.4 software to conduct the pooled effect size of every potential statistically significant factor. Results. 13 articles with a total of 5967 patients with pituitary adenoma and 405 cases of postoperative CSF Leak were finally included, accounting for 6.79%. All of the 13 articles had a quality $\text{score}>5$ , indicating good quality. Meta-analysis showed that patient age ( $\text{OR}=0.71$ , 95% CI (0.41, 1.20), $P=0.20$ ) was not a factor influencing postoperative CSF Leak, while BMI ( $\text{MD}=2.26$ , 95% CI (1.31, 3.20), $P<0.00001$ ), tumor size ( $\text{MD}=1.35$ , 95% CI (0.22, 2.49), $P=0.02$ ), whether a second operation was performed ( $\text{OR}=2.20$ , 95% CI (1.45, 3.33), $P=0.0002$ ), and intraoperative CSF Leak ( $\text{OR}=8.88$ , 95% CI (3.64, 21.69), $P<0.00001$ ) were risk factors for postoperative CSF Leak in patients. Discussion. BMI, tumor size, reoperation, and intraoperative CSF Leak are the risk factors of postoperative CSF Leak. However, not all the factors were covered in this study, it is still worth continuing to deeply investigate in this topic.