Acute spontaneous subdural haematoma after transsphenoidal surgery

Incidence and risk factors of subdural hematoma after intraoperative cerebrospinal fluid leakage during the transsphenoidal approach

PURPOSE

The transsphenoidal approach (TSA) is regarded as the first line of treatment for sellar and suprasellar lesions. There are only few case reports of postoperative subdural hematoma after TSA and extended transsphenoidal approach (eTSA), and the detailed incidence and risk factors for this complication are still unknown. We reviewed the incidence and risk factors for subdural hematoma after TSA and eTSA.

METHODS

Between January 1, 2013 and December 31, 2014, 165 consecutive patients underwent TSA or eTSA at Nagoya University Hospital and Nagoya Daini Red Cross Hospital. Fifty-one patients experienced intraoperative CSF leakage. Postoperative subdural hematoma was observed in 10 patients, all of whom experienced intraoperative CSF leakage. We reviewed clinical data including CT and MR images and examined factors related to subdural hematoma among patients with intraoperative CSF leakage.

RESULTS

In univariate statistical analyses, risk factors for postoperative subdural hematoma were advanced age, high Evans' index, and preoperative hypopituitarism. These factors were also significant in the multivariate logistic regression analysis. There were no statistical differences in sex, tumor size, approach methods, preoperative diabetes insipidus, or degree of intraoperative CSF leakage.

CONCLUSIONS

The incidence of postoperative subdural hematoma after intraoperative CSF leakage during TSA and eTSA was higher than the incidence reported in patients after craniotomy. Intraoperative CSF leakage should be avoided as much as possible, especially in patients with brain atrophy and/or enlargement of the ventricular system, even if the intent of the reconstruction technique is authenticity. In addition, patients with hypopituitarism should be carefully followed up after surgery.

Endoscopic endonasal craniotomy in the management of selected ethmoidal malignancies: the University of Pisa experience

The authors reviewed the medical records of patients who had undergone endoscopic endonasal craniotomy in our department between 2005 and 2009. Thirteen patients were included in this study: 12 males and 1 female. Patients were affected by ethmoidal malignancies abutting or involving the anterior skull base. In all the patients the anterior skull base was drilled down. Nine patients underwent dural resection. The procedure always included a skull base reconstruction. Postoperative complications included CSF leak, subdural haematoma and pneumocephalus. Our results show that endoscopic endonasal surgery can be a viable alternative to anterior craniofacial resection in the management of selected ethmoidal malignancies. The limited morbidity and high success rate fit well with the data in the literature and make this treatment option advisable.