The Risk of CSF Rhinorrhea from Early Initiation of CPAP after Transsphenoidal Surgery with Autologous Abdominal Fat Graft Repair

Study Design: Single institution, retrospective cohort study.

Objective: To assess the risk of cerebrospinal fluid (CSF) rhinorrhea in patients who initiate continuous positive airway pressure (CPAP) early after transsphenoidal approach craniotomy for resection of pituitary tumor with autologous abdominal fat graft repair.

Summary of Background Data: Obstructive sleep apnea is a common disorder affecting 17 to 22% of adult population with an increasing prevalence of patients requiring CPAP to reduce risks for cardiopulmonary disease and other comorbidities. Though transsphenoidal surgery is the standard approach for the treatment of sellar lesions with high rates of success, CSF leak remains the main non-endocrine postoperative complication. Autologous grafting using fat, fascia lata, or muscle is a well-described technique to reconstruct the sella and anterior skull base. It remains unclear whether an early initiation of CPAP after transsphenoidal surgery with fat graft increases the risk for CSF leak.

Methods: Data from 652 consecutive patients undergoing microscopic transsphenoidal approach and autologous fat graft repair between December 2017 and December 2021 was retrospectively reviewed. A total of 486 patients underwent reconstruction of the sellar defect with abdominal fat graft.

Results: Among the 486 patients status post abdominal fat grafting, the diagnoses were the following: 412 pituitary adenomas (84.7%), 58 Rathke cleft cysts (9.8%), 14 craniopharyngiomas. Among these patients, 63 patients required CPAP at baseline and were initiated at discharge. Nineteen patients had persistent postoperative CSF leak requiring operation, including three on CPAP. The relative risk for CSF leak in the CPAP group compared with the non-CPAP group was 0.93 (95% CI: 0.65–1.08, p = 0.4485).

Conclusions: Early initiation of CPAP after transsphenoidal surgery with autologous abdominal fat grafting did not result in any increased risk for CSF leak. This represents a reasonable strategy for management of patients with sleep apnea after transsphenoidal surgery.

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Artikel online veröffentlicht:
05. Februar 2024