Endoskopik transsfenoidal hipofiz cerrahisinde intraoperatif BOS drenajının post-operatif rinore üzerine etkisi

Amaç: İntraoperatif BOS kaçağı ve postoperatif rinore için faydalı olabilecek intraoperatif BOS drenajını tanımlayan az sayıda çalışma olduğundan, intraoperatif BOS kaçağını azalttığını, cerrahi alan kontrolünü artırdığını ve maksimum tümör rezeksiyonuna katkıda bulunduğunu gözlemlediğimiz, klinik pratiğimizde kullandığımız bu teknik ile ilgili deneyimlerimizi paylaşmak istedik. Gereç ve yöntem: Ağustos 2018-Aralık 2019 tarihleri arasında endoskopik endonasal yolla opere edilen 266 hipofiz adenomu vakası retrospektif olarak incelendi. Vakalar intraoperatif dönemde lomber drenaj katateri ile BOS drenajı uygulanan ve uygulanmayan olarak iki gruba ayrıldı. Başarı kriteri postoperatif ilk 2 ay içerisinde rinore görülmemesi olarak belirlendi. İki grup arasında rinore görülmesinde anlamlı fark olup olmadığı SPSS (version 20, IBM Corp.) yazılımı kullanılarak ve Ki-kare testi ile ortaya konulmaya çalışıldı.Bulgular: İntraoperatif BOS drenajı yapılan grupta 1 hastada post-operatif rinore görülürken BOS boşaltılmayan grupta 6 hastada post-operatif rinore görülmüştür ve bu fark istatistiki olarak anlamlı bulunmuştur (p<0,05). Sonuç: Bulgularımız intraoperatif BOS drenajı sayesinde atmosfer basıncı desteğiyle diafragma sella elevasyonunun sağlanarak intraoperatif BOS kaçağının ve dolayısıyla postoperatif rinore oranlarının azaldığı yönündedir.

Anahtar Kelimeler:

Bos kaçağı, hipofiz adenomu, transsfenoidal, endoskopik cerrahi, lomber drenaj

The effect of intraoperative CSF drainage on post-operative rhinorrhea in endoscopic transsphenoidal pituitary surgery

Purpose: Since few studies describing intraoperative CSF drainage that may be beneficial for intraoperative CSF leak and postoperative rhinorrhea, we wanted to share our experience with this technique, which we observe that it reduces intraoperative CSF leakage, increases surgical field control and contributes to maximum tumor resection.Methods and materials: 266 pituitary adenoma cases operated endonasal endoscopically between August 2018 and December 2019 were retrospectively analyzed. Patients were grouped as intraoperative CSF drained patients via a lumbar drainage shunt and patients who did not received any CSF drainage intraoperatively. The success criterion was determined as the absence of rhinorrhea in the first 2 months postoperatively. Whether there is a significant difference in the appearance of rhinorrhea between the two groups was tried to be determined by using SPSS (version 20, IBM Corp.) software and Chi-square test.Results: In the group where the intraoperative CSF was drained post-operative rhinorrhea was observed in 1 patient, whereas 6 patients in the non-CSF drainage group had post-operative rhinorrhea and this difference was statistically significant (p<0,05). Conclusions: Our findings suggest that diaphragma sellae elevation is achieved with the support of atmospheric pressure due to the preoperative CSF drainage, and therefore intraoperative CSF leakage and postoperative rhinorrhea rates are reduced.

Keywords:

CSF leak, pituitary adenoma, transsphenoidal, endoscopic surgery, lumbar drain,

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