Postoperative Management of OSA Following Endoscopic Pituitary Surgery: A Systematic Review

Objectives: There is currently no consensus on the appropriate timing of CPAP resumption in OSA patients following endoscopic pituitary surgery. The objectives of this study were to perform a systematic review of the literature and to evaluate the safety of early-CPAP resumption in OSA patients following surgery.

Methods: The study followed the Preferred Reporting Items for Systematic Reviews and Meta- Analysis (PRISMA) guidelines. Databases were searched using the following keywords: “sleep apnea,” “CPAP,” “endoscopic,” “skull base,” “transsphenoidal,” and “pituitary surgery.” Case reports, editorials, reviews, meta-analyses, unpublished, and abstract-only articles were all excluded.

Results: Five retrospective studies were identified, containing data from 267 OSA patients who underwent endoscopic skull base surgery. The mean age of patients from 4 studies (n = 198) was 56.3 years and the most common indication for surgery was endonasal transsphenoidal resection of pituitary adenoma. The timing of CPAP resumption following surgery was reported in 4 studies (n = 130), with 29 patients receiving CPAP therapy within two weeks postoperatively. The pooled rate of postoperative CSF leak associated with CPAP resumption was 4.0% (95% CI: 1.3–6.7%) from 3 studies (n = 27) and there were no cases of pneumocephalus in patients who had documented CPAP use in the early postoperative period (<2 weeks).

Conclusion: Early resumption of CPAP in OSA patients after endoscopic skull base surgery may be safer than previously believed. However, the literature remains deficient and additional studies with more thorough reporting of data are warranted to assess the true safety of reinitiating CPAP and other positive-pressure therapies in this challenging population.

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Artikel online veröffentlicht:
01. Februar 2023