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Increased Intracranial Pressure ll: Pathophysiology

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Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...

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Related Experiment Video

Updated: Jun 23, 2026

The Rabbit Blood-shunt Model for the Study of Acute and Late Sequelae of Subarachnoid Hemorrhage: Technical Aspects

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Published on: October 2, 2014

Analysis of Risk Factors and Development of a Prediction Model for Intraoperative Cerebrospinal Fluid Leakage During

Jie Wang^1,2, Zhuoyuan Li^1,2, Yunfeng Wang^1,2

¹Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.

Journal of Evidence-Based Medicine

|March 17, 2025

Summary

Cerebrospinal fluid (CSF) leakage after pituitary adenoma surgery is predicted by tumor size, texture, hepatic insufficiency, and complete removal. These factors aid in pre-operative risk assessment for improved patient outcomes.

Keywords:

anteroposterior diameter cerebrospinal fluid (CSF)pituitary adenoma transsphenoidal

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

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Published on: February 29, 2020

Area of Science:

Neurosurgery
Endocrinology
Oncology

Background:

Cerebrospinal fluid (CSF) leakage is a potential complication of transsphenoidal pituitary adenoma resection.
Identifying risk factors for intraoperative CSF leakage is crucial for patient prognosis and surgical planning.

Purpose of the Study:

To identify and analyze risk factors associated with intraoperative cerebrospinal fluid (CSF) leakage during transsphenoidal resection of pituitary adenomas.
To develop a predictive model for CSF leakage to aid in clinical decision-making.

Main Methods:

Retrospective study of 281 patients undergoing transsphenoidal pituitary adenoma resection.
Analysis of clinical data including tumor anteroposterior diameter, hepatic insufficiency, tumor texture, and surgical protocol (complete removal).

Main Results:

Cerebrospinal fluid (CSF) leakage occurred in 21.4% of patients.
Significant predictors for CSF leakage included larger anteroposterior tumor diameter (≥2 cm), tough tumor texture, hepatic insufficiency, and complete tumor removal.
A multifactorial logistic regression model demonstrated an AUC of 0.804 for predicting CSF leakage.

Conclusions:

Pre-operative assessment of tumor anteroposterior diameter, texture, hepatic insufficiency, and surgical strategy can help predict the risk of CSF leakage.
The findings provide a valuable reference for risk stratification and clinical management of patients undergoing pituitary adenoma surgery.