{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T11:56:36Z","timestamp":1792842996909,"version":"4.5.0"},"reference-count":25,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Cerebrospinal fluid (CSF) rhinorrhea is among the most common complications following transsphenoidal surgery for sellar region lesions. The aim of this study was to review the authors\u2019 institutional experience in identifying, repairing, and treating CSF leaks associated with direct endonasal transsphenoidal operations.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The authors performed a retrospective review of cases involving surgical treatment of pituitary adenomas and other sellar lesions at the University of Southern California between December 1995 and March 2016. Inclusion criteria included all pathology of the sellar region approached via a direct microscopic or endoscopic endonasal transsphenoidal approach. Demographics, pathology, intraoperative and postoperative CSF leak rates, and other complications were recorded and analyzed. A literature review of the incidence of CSF leaks associated with the direct endonasal transsphenoidal approach to pituitary lesions was conducted.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>A total of 1002 patients met the inclusion criteria and their cases were subsequently analyzed. Preoperative diagnoses included pituitary adenomas in 855 cases (85.4%), Rathke\u2019s cleft cyst in 94 (9.4%), and other sellar lesions in 53 (5.2%). Lesions with a diameter \u2265 1 cm made up 49% of the series. Intraoperative repair of an identified CSF leak was performed in 375 cases (37.4%) using autologous fat, fascia, or both. An additional 92 patients (9.2%) underwent empirical sellar reconstruction without evidence of an intraoperative CSF leak. Postoperative CSF leaks developed in 26 patients (2.6%), including 13 (1.3% of the overall group) in whom no intraoperative leak was identified. Among the 26 patients who developed a postoperative CSF leak, 13 were noted to have intraoperative leak and underwent sellar repair while the remaining 13 did not have an intraoperative leak or sellar repair. No patients who underwent empirical sellar repair without an intraoperative leak developed a postoperative leak. Eight patients underwent additional surgery (0.8% reoperation rate) for CSF leak repair, and 18 were successfully treated with lumbar drainage or lumbar puncture alone. The incidence of postoperative CSF rhinorrhea in this series was compared with that in 11 other reported series that met inclusion criteria, with incidence rates ranging between 0.6% and 12.1%.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>In this large series, half of the patients who developed postoperative CSF rhinorrhea had no evidence of intraoperative CSF leakage. Unidentified intraoperative CSF leaks and\/or delayed development of CSF fistulas are equally important sources of postoperative CSF rhinorrhea as the lack of employing effective CSF leak repair methods. Empirical sellar reconstruction in the absence of an intraoperative CSF leak may be of benefit following resection of large tumors, especially if the arachnoid is thinned out and herniates into the sella.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2017.4.jns162451","type":"journal-article","created":{"date-parts":[[2017,9,29]],"date-time":"2017-09-29T13:59:10Z","timestamp":1506693550000},"page":"425-429","source":"Crossref","is-referenced-by-count":80,"title":["Identification and repair of intraoperative cerebrospinal fluid leaks in endonasal transsphenoidal pituitary surgery: surgical experience in a series of 1002 patients"],"prefix":"10.3171","volume":"129","author":[{"given":"Ben A.","family":"Strickland","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Lucas","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brianna","family":"Harris","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwin","family":"Kulubya","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Bakhsheshian","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Liu","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bozena","family":"Wrobel","sequence":"additional","affiliation":[{"name":"Otolaryngology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D.","family":"Carmichael","sequence":"additional","affiliation":[{"name":"Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Weiss","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Zada","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Pituitary","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1007\/s11102-011-0368-2","article-title":"Complications of endoscopic surgery of the pituitary adenomas: analysis of 570 patients and review of the literature","volume":"15","author":"Berker M","year":"2012","unstructured":"Berker M, Hazer DB, Yucci T, Gurlek A, Cila A, Aldur M, : Complications of endoscopic surgery of the pituitary adenomas: analysis of 570 patients and review of the literature. Pituitary 15:288\u2013300, 201210.1007\/s11102-011-0368-222161543"},{"key":"b2","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1227\/00006123-198706000-00017","article-title":"Incidence and management of complications of transsphenoidal operation for pituitary adenomas","volume":"20","author":"Black PM","year":"1987","unstructured":"Black PM, Zervas NT, Candia GL: Incidence and management of complications of transsphenoidal operation for pituitary adenomas. Neurosurgery 20:920\u2013924, 198710.1227\/00006123-198706000-000173614573"},{"key":"b3","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1365","DOI":"10.1097\/00006123-200212000-00006","article-title":"Sellar repair in endoscopic endonasal transsphenoidal surgery: results of 170 cases","volume":"51","author":"Cappabianca P","year":"2002","unstructured":"Cappabianca P, Cavallo LM, Esposito F, Valente V, De Divitiis E: Sellar repair in endoscopic endonasal transsphenoidal surgery: results of 170 cases. Neurosurgery 51:1365\u20131372, 200210.1097\/00006123-200212000-0000612445341"},{"key":"b4","series-title":"J Clin Neurosci","doi-asserted-by":"publisher","first-page":"786","DOI":"10.1016\/j.jocn.2008.09.002","article-title":"Surgical complications after endoscopic transsphenoidal pituitary surgery","volume":"16","author":"Charalampaki P","year":"2009","unstructured":"Charalampaki P, Ayyad A, Kockro RA, Perneczky A: Surgical complications after endoscopic transsphenoidal pituitary surgery. J Clin Neurosci 16:786\u2013789, 20091928928710.1016\/j.jocn.2008.09.002"},{"key":"b5","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1097\/00006123-199702000-00001","article-title":"Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience","volume":"40","author":"Ciric I","year":"1997","unstructured":"Ciric I, Ragin A, Baumgartner C, Pierce D: Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery 40:225\u2013237, 199710.1097\/00006123-199702000-000019007854"},{"issue":"3","key":"b6","series-title":"Neurosurg Focus","first-page":"E11","article-title":"Simple closure following transsphenoidal surgery. Technical note","volume":"20","author":"Couldwell WT","year":"2006","unstructured":"Couldwell WT, Kan P, Weiss MH: Simple closure following transsphenoidal surgery. Technical note. Neurosurg Focus 20(3):E11\u2013E13, 2006"},{"key":"b7","series-title":"Can J Neurol Sci","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1017\/S0317167100013950","article-title":"Outcomes of surgically treated giant pituitary tumours","volume":"39","author":"Cusimano MD","year":"2012","unstructured":"Cusimano MD, Kan P, Nassiri F, Anderson J, Goguen J, Vanek I, : Outcomes of surgically treated giant pituitary tumours. Can J Neurol Sci 39:446\u2013457, 20122272885110.1017\/S0317167100013950"},{"key":"b8","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1227\/NEU.0000000000000563","article-title":"Long-term results of endonasal endoscopic transsphenoidal resection of nonfunctioning pituitary macroadenomas","volume":"76","author":"Dallapiazza RF","year":"2015","unstructured":"Dallapiazza RF, Grober Y, Starke RM, Laws ER Jr, Jane JA Jr: Long-term results of endonasal endoscopic transsphenoidal resection of nonfunctioning pituitary macroadenomas. Neurosurgery 76:42\u201353, 20152525527110.1227\/NEU.0000000000000563"},{"key":"b9","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1227\/01.neu.0000325862.83961.12","article-title":"Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series","volume":"62","author":"Dehdashti AR","year":"2008","unstructured":"Dehdashti AR, Ganna A, Karabatsou K, Gentili F: Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series. Neurosurgery 62:1006\u20131017, 200810.1227\/01.neu.0000325862.83961.1218580798"},{"issue":"4 Suppl 2","key":"b10","series-title":"Neurosurgery","first-page":"295","article-title":"Graded repair of cranial base defects and cerebrospinal fluid leaks in transsphenoidal surgery","volume":"60","author":"Esposito F","year":"2007","unstructured":"Esposito F, Dusick JR, Fatemi N, Kelly DF: Graded repair of cranial base defects and cerebrospinal fluid leaks in transsphenoidal surgery. Neurosurgery 60 (4 Suppl 2):295\u2013304, 200717415166"},{"key":"b11","series-title":"Neuroendocrinology","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1159\/000095534","article-title":"The endoscopic versus the traditional approach in pituitary surgery","volume":"83","author":"Frank G","year":"2006","unstructured":"Frank G, Pasquini E, Farneti G, Mazzatenta D, Sciarretta V, Grasso V, : The endoscopic versus the traditional approach in pituitary surgery. Neuroendocrinology 83:240\u2013248, 20061704738910.1159\/000095534"},{"key":"b12","series-title":"Pituitary","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1007\/s11102-010-0280-1","article-title":"Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients","volume":"14","author":"Gondim JA","year":"2011","unstructured":"Gondim JA, Almeida JP, Albuquerque LA, Schops M, Gomes E, Ferraz T, : Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients. Pituitary 14:174\u2013183, 20112118127810.1007\/s11102-010-0280-1"},{"key":"b13","series-title":"Laryngoscope","doi-asserted-by":"publisher","first-page":"1882","DOI":"10.1097\/01.mlg.0000234933.37779.e4","article-title":"A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap","volume":"116","author":"Hadad G","year":"2006","unstructured":"Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, : A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 116:1882\u20131886, 200610.1097\/01.mlg.0000234933.37779.e417003708"},{"issue":"1 Suppl Operative","key":"b14","series-title":"Neurosurgery","first-page":"144","article-title":"Management and implications of intraoperative cerebrospinal fluid leak in transnasoseptal transsphenoidal microsurgery","volume":"68","author":"Kaptain GJ","year":"2011","unstructured":"Kaptain GJ, Kanter AS, Hamilton DK, Laws ER: Management and implications of intraoperative cerebrospinal fluid leak in transnasoseptal transsphenoidal microsurgery. Neurosurgery 68 (1 Suppl Operative):144\u2013151, 201121206313"},{"key":"b15","series-title":"J Neurooncol","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1007\/s11060-013-1315-z","article-title":"Contemporary neurosurgical techniques for pituitary tumor resection","volume":"117","author":"Lee JY","year":"2014","unstructured":"Lee JY, Bohman LE, Bergsneider M: Contemporary neurosurgical techniques for pituitary tumor resection. J Neurooncol 117:437\u2013444, 20142426453410.1007\/s11060-013-1315-z"},{"key":"b16","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1016\/j.wneu.2016.02.059","article-title":"Complications related to the endoscopic endonasal transsphenoidal approach for nonfunctioning pituitary macroadenomas in 300 consecutive patients","volume":"89","author":"Magro E","year":"2016","unstructured":"Magro E, Graillon T, Lassave J, Castinetti F, Boissonneau S, Tabouret E, : Complications related to the endoscopic endonasal transsphenoidal approach for nonfunctioning pituitary macroadenomas in 300 consecutive patients. World Neurosurg 89:442\u2013453, 201610.1016\/j.wneu.2016.02.05926902781"},{"key":"b17","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1299","DOI":"10.3171\/2012.3.JNS112160","article-title":"Prevention of intraoperative cerebrospinal fluid leaks by lumbar cerebrospinal fluid drainage during surgery for pituitary macroadenomas","volume":"116","author":"Mehta GU","year":"2012","unstructured":"Mehta GU, Oldfield EH: Prevention of intraoperative cerebrospinal fluid leaks by lumbar cerebrospinal fluid drainage during surgery for pituitary macroadenomas. J Neurosurg 116:1299\u20131303, 20122248279310.3171\/2012.3.JNS112160"},{"issue":"4","key":"b18","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E11","DOI":"10.3171\/2011.1.FOCUS10308","article-title":"Evidence of improved surgical outcome following endoscopy for nonfunctioning pituitary adenoma removal","volume":"30","author":"Messerer M","year":"2011","unstructured":"Messerer M, De Battista JC, Raverot G, Kassis S, Dubourg J, Lapras V, : Evidence of improved surgical outcome following endoscopy for nonfunctioning pituitary adenoma removal. Neurosurg Focus 30(4):E11, 201110.3171\/2011.1.FOCUS1030821456922"},{"key":"b19","series-title":"Skull Base Surg","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1055\/s-2008-1058631","article-title":"Perioperative complications of transseptosphenoidal excision for pituitary adenomas","volume":"6","author":"Persky MS","year":"1996","unstructured":"Persky MS, Brunner E, Cooper PR, Cohen NL: Perioperative complications of transseptosphenoidal excision for pituitary adenomas. Skull Base Surg 6:231\u2013235, 19961717101410.1055\/s-2008-1058631"},{"key":"b20","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"621","DOI":"10.3171\/2014.12.JNS14995","article-title":"Sensitivity and specificity of intrathecal fluorescein and white light excitation for detecting intraoperative cerebrospinal fluid leak in endoscopic skull base surgery: a prospective study","volume":"124","author":"Raza SM","year":"2016","unstructured":"Raza SM, Banu MA, Donaldson A, Patel KS, Anand VK, Schwartz TH: Sensitivity and specificity of intrathecal fluorescein and white light excitation for detecting intraoperative cerebrospinal fluid leak in endoscopic skull base surgery: a prospective study. J Neurosurg 124:621\u2013626, 201610.3171\/2014.12.JNS1499526295912"},{"key":"b21","series-title":"Minim Invasive Neurosurg","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1055\/s-0029-1246161","article-title":"Surgical repair of persisting CSF leaks following standard or extended endoscopic transsphenoidal surgery for pituitary tumor","volume":"53","author":"Sciarretta V","year":"2010","unstructured":"Sciarretta V, Mazzatenta D, Ciarpaglini R, Pasquini E, Farneti G, Frank G: Surgical repair of persisting CSF leaks following standard or extended endoscopic transsphenoidal surgery for pituitary tumor. Minim Invasive Neurosurg 53:55\u201359, 201010.1055\/s-0029-124616120533135"},{"key":"b22","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"545","DOI":"10.3171\/2007.12.17635","article-title":"Endoscopic pituitary surgery: a systematic review and meta-analysis","volume":"111","author":"Tabaee A","year":"2009","unstructured":"Tabaee A, Anand VK, Barr\u00f3n Y, Hiltzik DH, Brown SM, Kacker A, : Endoscopic pituitary surgery: a systematic review and meta-analysis. J Neurosurg 111:545\u2013554, 20091919946110.3171\/2007.12.17635"},{"key":"b23","series-title":"Surg Endosc","doi-asserted-by":"publisher","first-page":"1270","DOI":"10.1007\/s00464-014-3815-0","article-title":"Endoscopic endonasal transsphenoidal surgery of 1,166 pituitary adenomas","volume":"29","author":"Wang F","year":"2015","unstructured":"Wang F, Zhou T, Wei S, Meng X, Zhang J, Hou Y, : Endoscopic endonasal transsphenoidal surgery of 1,166 pituitary adenomas. Surg Endosc 29:1270\u20131280, 201510.1007\/s00464-014-3815-025270611"},{"key":"b24","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1007\/s00701-010-0862-8","article-title":"Low-grade CSF leaks in endoscopic trans-sphenoidal pituitary surgery: efficacy of a simple and fully synthetic repair with a hydrogel sealant","volume":"153","author":"Wang YY","year":"2011","unstructured":"Wang YY, Kearney T, Gnanalingham KK: Low-grade CSF leaks in endoscopic trans-sphenoidal pituitary surgery: efficacy of a simple and fully synthetic repair with a hydrogel sealant. Acta Neurochir (Wien) 153:815\u2013822, 201110.1007\/s00701-010-0862-821181543"},{"key":"b25","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"1572","DOI":"10.1016\/j.wneu.2015.08.035","article-title":"Pure endoscopic endonasal transsphenoidal approach for nonfunctioning pituitary adenomas in the elderly: surgical outcomes and complications in 158 patients","volume":"84","author":"Zhan R","year":"2015","unstructured":"Zhan R, Ma Z, Wang D, Li X: Pure endoscopic endonasal transsphenoidal approach for nonfunctioning pituitary adenomas in the elderly: surgical outcomes and complications in 158 patients. World Neurosurg 84:1572\u20131578, 20152634142810.1016\/j.wneu.2015.08.035"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/129\/2\/article-p425.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/129\/2\/article-p425.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/129\/2\/article-p425.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T02:55:19Z","timestamp":1743389719000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/129\/2\/article-p425.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,8]]},"references-count":25,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2017.4.jns162451","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,8]]}}}