{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T18:26:15Z","timestamp":1783103175060,"version":"3.54.6"},"reference-count":19,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2012,6]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Cerebrospinal fluid leakage is a major complication of transsphenoidal surgery. An intraoperative CSF leak, which occurs in up to 50% of pituitary tumor cases, is the only modifiable risk factor for postoperative leaks. Although several techniques have been described for surgical repair when an intraoperative leak is noted, none has been proposed to prevent an intraoperative CSF leak. The authors postulated that intraoperative CSF drainage would diminish tension on the arachnoid, decrease the rate of intraoperative CSF leakage during surgery for larger tumors, and reduce the need for surgical repair of CSF leaks.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The results of 114 transsphenoidal operations for pituitary macroadenoma performed without intraoperative CSF drainage were compared with the findings from 44 cases in which a lumbar subarachnoid catheter was placed before surgery to drain CSF at the time of dural exposure and tumor removal.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Cerebrospinal fluid drainage reduced the rate of intraoperative CSF leakage from 41% to 5% (p &lt; 0.001). This reduction occurred in macroadenomas with (from 57% to 5%, p &lt; 0.001) and those without suprasellar extension (from 29% to 0%, p = 0.31). The rate of postoperative CSF leakage was similar (5% vs 5%), despite the fact that intraoperative CSF drainage reduced the need for operative repair (from 32% to 5%, p &lt; 0.001). There were no significant catheter-related complications.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Cerebrospinal fluid drainage during transsphenoidal surgery for macroadenomas reduces the rate of intraoperative CSF leaks. This preventative measure obviated the need for surgical repair of intraoperative CSF leaks using autologous fat graft placement, other operative techniques, postoperative lumbar drainage, and\/or reoperation in most patients and is associated with minimal risks.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2012.3.jns112160","type":"journal-article","created":{"date-parts":[[2012,4,6]],"date-time":"2012-04-06T14:14:26Z","timestamp":1333721666000},"page":"1299-1303","source":"Crossref","is-referenced-by-count":77,"title":["Prevention of intraoperative cerebrospinal fluid leaks by lumbar cerebrospinal fluid drainage during surgery for pituitary macroadenomas"],"prefix":"10.3171","volume":"116","author":[{"given":"Gautam U.","family":"Mehta","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward H.","family":"Oldfield","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns112160","series-title":"J Neurosurg","first-page":"634","article-title":"Transsphenoidal microsurgical removal of growth hormone-secreting pituitary adenomas. 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Technical note","volume":"109","author":"Kerr","year":"2008"},{"key":"b11-jns112160","series-title":"J Clin Endocrinol Metab","first-page":"1509","article-title":"Guidelines for acromegaly management: an update","volume":"94","author":"Melmed","year":"2009"},{"key":"b12-jns112160","series-title":"J Neurosurg","first-page":"7","article-title":"Development of a histological pseudocapsule and its use as a surgical capsule in the excision of pituitary tumors","volume":"104","author":"Oldfield","year":"2006"},{"key":"b13-jns112160","series-title":"The Pituitary Adenoma","first-page":"507","author":"Post","year":"1980"},{"key":"b14-jns112160","series-title":"J Neurosurg","first-page":"737","article-title":"Usefulness of beta 2-transferrin assay in the detection of cerebrospinal fluid leaks following head injury","volume":"77","author":"Ryall","year":"1992"},{"key":"b15-jns112160","series-title":"Acta Neurochir (Wien)","first-page":"13","article-title":"Management of intra-operative cerebrospinal fluid leak in transnasal transsphenoidal pituitary microsurgery: use of post-operative lumbar drain and sellar reconstruction without fat packing","volume":"148","author":"Sade","year":"2006"},{"key":"b16-jns112160","series-title":"J Neurosurg","first-page":"762","article-title":"Sellar reconstruction with resorbable vicryl patches, gelatin foam, and fibrin glue in transsphenoidal surgery: a 10-year experience with 376 patients","volume":"93","author":"Seiler","year":"2000"},{"key":"b17-jns112160","series-title":"Laryngoscope","first-page":"1283","article-title":"Incidence, etiology, and management of cerebrospinal fluid leaks following trans-sphenoidal surgery","volume":"113","author":"Shiley","year":"2003"},{"key":"b18-jns112160","series-title":"Laryngoscope","first-page":"1133","article-title":"Algorithm for reconstruction after endoscopic pituitary and skull base surgery","volume":"117","author":"Tabaee","year":"2007"},{"issue":"4","key":"b19-jns112160","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Patterns of extrasellar extension in growth hormone-secreting and nonfunctional pituitary macroadenomas","volume":"29","author":"Zada","year":"2010"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/116\/6\/article-p1299.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/116\/6\/article-p1299.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/116\/6\/article-p1299.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T00:48:21Z","timestamp":1679878101000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/116\/6\/article-p1299.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2012,6]]},"references-count":19,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2012.3.jns112160","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,6]]}}}