The sellar barrier on preoperative imaging predicts intraoperative cerebrospinal fluid leak: a prospective multicenter c
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The sellar barrier on preoperative imaging predicts intraoperative cerebrospinal fluid leak: a prospective multicenter cohort study Juan F. Villalonga1 · Domenico Solari2 · Luigi M. Cavallo2 · Paolo Cappabianca2 · Daniel M. Prevedello3 · Ricardo Carrau3 · Rafael Martinez‑Perez3 · Douglas Hardesty3 · Christoph Fuchssteiner4 · Amparo Saenz1 · Rosaria Viola Abbritti5 · Cristopher Valencia‑Ramos6 · Ariel Kaen7 · Anne‑Laure Bernat5 · Eugenio Cardenas7 · Lena Hirtler4 · Juan Luis Gomez‑Amador6 · James Liu8 · Sebastien Froelich5 · Andrés Cervio9 · Alvaro Campero1 Accepted: 5 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background The type of sellar barrier observed between a pituitary tumor and cerebrospinal fluid (CSF) on preoperative magnetic resonance imaging (MRI) may predict intraoperative CSF leak during endonasal pituitary surgery. This is the first multicentric prospective cohort trial to study the sellar barrier concept and CSF leak rate during endoscopic pituitary surgery. Methods This multi-center, international study enrolled patients operated for pituitary adenomas via fully endoscopic endonasal surgery over a period of 4 months. The independent variable was the subtype of sellar barrier observed on preoperative MRI (strong, mixed or weak); the dependent variable was the presence of an intraoperative CSF leak. The primary goal was to determine the association between a particular type of sellar barrier and the risk of intraoperative CSF leak. Appropriate statistical methods were then applied for data analysis. Results Over the study period, 310 patients underwent endoscopic endonasal surgery for pituitary tumor. Preoperative imaging revealed a weak sellar barrier in 73 (23.55%), a mixed sellar barrier in 75 (24.19%), and a strong sellar barrier in 162 (52.26%) patients. The overall rate of intraoperative CSF leak among all patients was 69 (22.26%). A strong sellar-type barrier was associated with significantly reduced rate of intraoperative CSF leak (RR = 0.08; 95% CI 0.03–0.19; p
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