The risk of cerebrospinal fluid rhinorrhea from early resumption of positive pressure ventilation after transsphenoidal surgery with autologous fat graft repair.

Abstract

Multiple closure techniques may prevent CSF leak after transsphenoidal surgery for sellar lesions. In patients with obstructive sleep apnea requiring positive pressure ventilation (PPV), the optimal closure technique remains unclear. The authors assessed the efficacy of autologous abdominal fat graft repair for preventing CSF leaks in patients reinitiating PPV early after transsphenoidal surgery. A retrospective cohort study was performed to review the records of consecutive patients who underwent microscopic transsphenoidal surgery with autologous fat (with or without fascia) graft repair between January 2018 and December 2024. Rates of CSF leak and other postoperative complications were compared based on the need for postoperative PPV. Among the 609 included patients (84.1% pituitary adenomas, 12.0% Rathke's cleft cysts, 3.1% craniopharyngiomas, 0.8% meningiomas), 73 required PPV at baseline that was reinitiated at discharge (mean postoperative day 3.5 ± 2.9). No significant baseline differences existed between these groups. Twenty patients had persistent CSF leaks requiring postoperative CSF diversion or reoperation (3 PPV patients [4.1%] and 17 non-PPV patients [3.2%]; p = 0.99). Of these, the leak developed after discharge in 1 PPV patient (1.4%) and 6 non-PPV patients (1.1%) (p = 0.837). No difference in relative risk existed for CSF leak in the PPV and non-PPV groups (RR 1.16, 95% CI 0.320-4.198; p = 0.8108). There were no differences in other postoperative complication rates between groups. Early initiation of PPV after transsphenoidal surgery with autologous abdominal fat (with or without fascia) grafting did not increase the risk of CSF leak, suggesting that it reasonably prevents leaks in patients with sleep apnea after transsphenoidal surgery.