Comparison of Microscopic versus Endoscopic CSF Leak Rates: A Retrospective 12-Year Study

Objective: The purpose of this article is to compare the CSF leak rate for microscopic versus endoscopic approaches to pituitary region pathologies.

Design: Retrospective chart review of the cases between 1999 and 2012 for all pathologies.

Patients/Materials and Methods: A database of all anterior skull base cases between 1999 and 2012 and a database of cases with a postoperative CSF that needed to be readdressed with a second operation were created. Demographic data and operative reports were collected and analyzed qualitatively.

Results: For the microscopic approach, a 4% leak rate occurred in more than 250 cases. An overwhelming number of the cases were pituitary adenomas, with a small number of other pathologies. No extended transsphenoidal procedures were performed with the microscope, and no meningiomas were operated on. With the introduction of the endoscope, an increased range of pathologies was addressed, particularly meningiomas, via the extended approach. An increased CSF leak rate was initially seen relating to a number of factors, including a learning curve for using the endoscope, better visualization, and increased resection of tumors (with an associated increased leak rate), the variety of ways of repairing the defect, and different personnel performing the closure (ENTs, neurosurgeons). The CSF leak rate now approaches 10%.

Conclusions: The endoscopic approach allows better access to the skull base and increased visualization of tumors. There are greater complexities with respect to preventing a CSF leak but with experience, this can be overcome.