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The sellar barrier on preoperative imaging predicts intraoperative cerebrospinal fluid leak: a prospective multicenter cohort study

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dc.contributor.author Villalonga, Juan Francisco
dc.contributor.author Solari, Domenico
dc.contributor.author Cavallo, Luigi M.
dc.contributor.author Cappabianca, P
dc.contributor.author Prevedello, Daniel M.
dc.contributor.author Carrau, Ricardo
dc.contributor.author Martínez Pérez, Rafael
dc.contributor.author Hardesty, Douglas
dc.contributor.author Fuchssteiner, Christoph
dc.contributor.author Saenz, Amparo
dc.contributor.author Abbritti, Rosaria Viola
dc.contributor.author Valencia Ramos, Cristopher
dc.contributor.author Kaen, Ariel
dc.contributor.author Bernat, Anne-Laure
dc.contributor.author Cardenas, Eugenio
dc.contributor.author Hirtler, Lena
dc.contributor.author Gómez Amador, Juan Luis
dc.contributor.author Liu, James
dc.contributor.author Froelich, Sebastien
dc.contributor.author Cervio, Andrés Eduardo
dc.contributor.author Campero, Álvaro
dc.date.accessioned 2021-05-17T11:55:48Z
dc.date.available 2021-05-17T11:55:48Z
dc.date.issued 2020-09-12
dc.identifier.citation Villalonga, J.F., Solari, D., Cavallo, L.M., Cappabianca, P., Prevedello, D.M., Carrau, R., Martinez-Perez, R., Hardesty, D., Fuchssteiner, C., Saenz, A., Abbritti, R.V., Valencia-Ramos, C., Kaen, A., Bernat, A.-L., Cardenas, E., Hirtler, L., Gomez-Amador, J.L., Liu, J., Froelich, S., Cervio, A., Campero, A., 2020. The sellar barrier on preoperative imaging predicts intraoperative cerebrospinal fluid leak: a prospective multicenter cohort study. Pituitary. https://doi.org/10.1007/s11102-020-01082-8 es_ES
dc.identifier.uri https://repositorio.fleni.org.ar/xmlui/handle/123456789/482
dc.identifier.uri https://doi.org/10.1007/s11102-020-01082-8
dc.description.abstract Background: The type of sellar barrier observed between a pituitary tumor and cerebrospinal fluid (CSF) on preoperative magnetic resonance imaging (MRI) may predict intraoperative CSF leak during endonasal pituitary surgery. This is the first multicentric prospective cohort trial to study the sellar barrier concept and CSF leak rate during endoscopic pituitary surgery. Methods: This multi-center, international study enrolled patients operated for pituitary adenomas via fully endoscopic endonasal surgery over a period of 4 months. The independent variable was the subtype of sellar barrier observed on preoperative MRI (strong, mixed or weak); the dependent variable was the presence of an intraoperative CSF leak. The primary goal was to determine the association between a particular type of sellar barrier and the risk of intraoperative CSF leak. Appropriate statistical methods were then applied for data analysis. Results: Over the study period, 310 patients underwent endoscopic endonasal surgery for pituitary tumor. Preoperative imaging revealed a weak sellar barrier in 73 (23.55%), a mixed sellar barrier in 75 (24.19%), and a strong sellar barrier in 162 (52.26%) patients. The overall rate of intraoperative CSF leak among all patients was 69 (22.26%). A strong sellar-type barrier was associated with significantly reduced rate of intraoperative CSF leak (RR = 0.08; 95% CI 0.03-0.19; p < 0.0001), while a weak sellar barrier associated with higher rates of CSF leak (RR = 8.54; 95% CI 5.4-13.5; p < 0.0001). Conclusions: The preoperative MRI of pituitary patients can suggest intraoperative CSF leak rates, utilizing the concept of the sellar barrier. Patients with a weak sellar barrier carry a higher risk for an intraoperative CSF leak, whereas a strong sellar barrier on MRI seems to mitigate intraoperative CSF leak. We propose that preoperatively assessment of the sellar barrier can prepare surgeons for intraoperative CSF leak repair. es_ES
dc.language.iso eng es_ES
dc.publisher Kluwer Academic Publishers es_ES
dc.rights info:eu-repo/semantics/openAccess
dc.rights.uri https://creativecommons.org/licenses/by/2.5/ar/
dc.subject Pituitary Neoplasms es_ES
dc.subject Neoplasias Hipofisarias es_ES
dc.subject Skull Base es_ES
dc.subject Base del Cráneo es_ES
dc.title The sellar barrier on preoperative imaging predicts intraoperative cerebrospinal fluid leak: a prospective multicenter cohort study es_ES
dc.type info:eu-repo/semantics/article es_ES
dc.type info:eu-repo/semantics/publishedVersion
dc.description.fil Fil: Cervio, Andrés Eduardo. Fleni. Departamento de Neurocirugía; Argentina.
dc.description.fil Fil: Villalonga, Juan Francisco. Universidad Nacional de Tucumán. Facultad de Medicina; Argentina.
dc.description.fil Fil: Solari, Domenico. Università degli Studi di Napoli Federico II. Department of Neurosciences, Reproductive and Odontostomatological Sciences. Division of Neurosurgery: Italia.
dc.description.fil Fil: Cavallo, Luigi M. Università degli Studi di Napoli Federico II. Department of Neurosciences, Reproductive and Odontostomatological Sciences. Division of Neurosurgery: Italia.
dc.description.fil Fil: Cappabianca, P. Università degli Studi di Napoli Federico II. Department of Neurosciences, Reproductive and Odontostomatological Sciences. Division of Neurosurgery: Italia.
dc.description.fil Fil: Prevedello, Daniel M.The Ohio State University. Wexner Medical Center. Department of Neurological Surgery; Estados Unidos.
dc.description.fil Fil: Carrau, Ricardo.The Ohio State University. Wexner Medical Center. Department of Neurological Surgery; Estados Unidos.
dc.description.fil Fil: Martínez Pérez, Rafael.The Ohio State University. Wexner Medical Center. Department of Neurological Surgery; Estados Unidos.
dc.description.fil Fil: Hardesty, Douglas.The Ohio State University. Wexner Medical Center. Department of Neurological Surgery; Estados Unidos.
dc.description.fil Fil: Fuchssteiner, Christoph. Medical University of Vienna. Center for Anatomy and Cell Biology. Division of Anatomy; Austria.
dc.description.fil Fil: Saenz, Amparo. Universidad Nacional de Tucumán. Facultad de Medicina; Argentina.
dc.description.fil Fil: Abbritti, Rosaria Viola. Lariboisière University Hospital Assistance Publique; Francia.
dc.description.fil Fil: Valencia Ramos, Cristopher. Instituto Nacional de Neurología y Neurocirugía; México.
dc.description.fil Fil: Kaen, Ariel. Hospital Virgen del Rocío; España.
dc.description.fil Fil: Bernat, Anne-Laure. Lariboisière University Hospital Assistance Publique; Francia.
dc.description.fil Fil: Cardenas, Eugenio. Hospital Virgen del Rocío; España.
dc.description.fil Fil: Hirtler, Lena. Medical University of Vienna. Center for Anatomy and Cell Biology. Division of Anatomy; Austria.
dc.description.fil Fil: Gómez Amador, Juan Luis. Instituto Nacional de Neurología y Neurocirugía; México.
dc.description.fil Fil: Liu, James. Rutgers New Jersey Medical School; Estados Unidos.
dc.description.fil Fil: Froelich, Sebastien. Lariboisière University Hospital Assistance Publique; Francia.
dc.description.fil Fil: Campero, Álvaro. Universidad Nacional de Tucumán. Facultad de Medicina; Argentina.
dc.relation.ispartofCOUNTRY Estados Unidos
dc.relation.ispartofCITY Norwell
dc.relation.ispartofTITLE Pituitary
dc.relation.ispartofISSN 1573-7403
dc.type.snrd info:ar-repo/semantics/artículo es_ES


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