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Related Experiment Video

Updated: May 19, 2026

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
07:43

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

Published on: January 17, 2018

CSF fistulas after transsphenoidal pituitary surgery--a solved problem?

Muhammad Usman Malik1, Jens C Aberle, Joerg Flitsch

  • 1Department of Neurosurgery, Rawalpindi Medical College, HFH, Rawalpindi, Pakistan. usmalik7@gmail.com

Journal of Neurological Surgery. Part A, Central European Neurosurgery
|August 18, 2012
PubMed
Summary

Cerebrospinal fluid (CSF) fistulas are a complication of transsphenoidal surgery, particularly for nonadenomatous lesions. Persistent CSF fistulas may require advanced treatments like VP shunts, and higher rates are seen with other skull base surgeries.

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Area of Science:

  • Neurosurgery
  • Skull Base Surgery
  • Cerebrospinal Fluid Dynamics

Background:

  • Transsphenoidal surgery is a standard approach for intra- and suprasellar lesions.
  • While generally safe, complications like cerebrospinal fluid (CSF) fistulas can occur.
  • CSF fistulas pose significant risks, including meningitis.

Purpose of the Study:

  • To analyze the incidence of CSF fistulas after transsphenoidal surgery.
  • To identify risk factors associated with CSF fistulas.
  • To discuss treatment options for persistent CSF fistulas.

Main Methods:

  • A retrospective review of 363 transsphenoidal surgeries performed on 339 patients over 24 months.
  • Analysis of patient data for the occurrence of CSF fistulas and subsequent treatments.

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Last Updated: May 19, 2026

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
07:43

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

Published on: January 17, 2018

Intrathecal Application of a Fluorescent Dye for the Identification of Cerebrospinal Fluid Leaks in Cochlear Malformation
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  • Categorization of lesions into pituitary adenomas and nonadenomatous lesions.

    • Main Results:

    • CSF fistulas occurred in 1.77% of patients (6/339), with a higher incidence after surgery for nonadenomatous lesions (7%) compared to pituitary adenomas (0.7%).
    • Three patients with recurrent CSF fistulas required multiple resurgeries and lumbar drainage.
    • Two patients necessitated ventriculoperitoneal (VP) shunt implantation for persistent CSF leakage, and 0.59% developed meningitis.

    Conclusions:

    • CSF fistulas remain a challenge after transsphenoidal surgery, often requiring complex management.
    • Treatment failure can necessitate advanced interventions.
    • The use of transsphenoidal approach for other skull base lesions is associated with increased CSF fistula and meningitis rates.