The effect of materials and methods of the sella turcica bottom plastic surgery after transsphenoidal pituitary adenoma surgery on the incidence of nasal liquorrhea

Introduction. The endoscopic transsphenoidal approach has become much more widely used in the last decade as the main one for the removal of tumors of the cellular and parasellar regions, especially pituitary adenomas. Moreover, despite the low traumatic access and excellent visualization, nasal liquorrhea is still its main problem. The objective was to analyze the frequency of nasal liquorrhea after transsphenoidal endoscopic surgery of pituitary adenomas in the period from 2019 to 2022, to analyze materials and methods of its prevention and treatment.

Methods and materials. A retrospective analysis of the incidence of liquorrhea in 527 patients diagnosed with pituitary adenoma who underwent transsphenoidal endoscopic surgery in our clinic in the period from 2019 to 2022, as well as an analysis of the methods of plastic surgery of the postoperative defect of the base of the skull and its effectiveness. A comparative analysis of the frequency of postoperative nasal liquorrhea and the closure of the sella turcica bottom defect in 121 patients diagnosed with pituitary adenoma operated on by transsphenoidal endoscopy in the same time period by five inexperienced surgeons working in the same neurosurgical center and performing less than 50 such operations per year was carried out. The analysis of the presence/absence of correlation between the occurrence of postoperative liquorrhea and the demographic indicators of patients, the type, size and nature of adenoma growth was also performed. The patients were divided into two groups – operated on by «experienced» (more than 200 transsphenoidal operations per year) and «inexperienced» (less than 50 such operations) surgeons, respectively.

Results. Our result of a statistical analysis of the treatment results of 527 patients diagnosed with pituitary adenoma who underwent transsphenoidal endoscopic surgery showed a frequency of postoperative liquorrhea comparable to world literature data (0.9 %). There were no statistically significant differences in the frequency of liquorrhea depending on the type and materials of plastics. However, there has been a statistically significant increase in cases of liquorrhea in patients with larger tumors and with an antesellar growth direction. It is impossible not to note a significant difference in the frequency of intraoperative and postoperative liquorrhea, depending on the experience of the surgeon. An experienced surgeon had two times fewer cases of intraoperative liquorrhea and 16 times fewer cases of postoperative nasal liquorrhea.

Conclusion. Thus, over the past five years, we can note a significant decrease in the frequency of postoperative nasal liquorrhea after transsphenoidal surgery of pituitary adenomas, the emergence of many options and algorithms for closing the postoperative defect of the base of the skull to prevent and treat it. Simple low-traumatic plastic surgery methods are highly effective in solving this problem. It is necessary to strive reducing the frequency of use in surgical practice of more aggressive methods of closing the defect of the bottom of the sella turcica, including the collection of autologous tissues and cutting out the mucoperiosteal flap, without forced necessity.

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