Prevention of Cerebrospinal Fluid Fistulas in Pituitary Macroadenoma Surgeries: Role of Lumbar Drainage

Abstract

Introduction: Transsphenoidal surgery is effective in treating pituitary macroadenomas, but persistent cerebrospinal fluid (CSF) leakage remains a relevant complication. Strategies such as lumbar drainage of CSF have shown promise in preventing intraoperative fistulas, especially in cases with suprasellar extension. Objectives: This study aims to evaluate the efficacy and safety of lumbar drainage in preventing complications related to CSF fistulas. Method: A literature review was conducted, including articles from 2004 to 2018, selected from PubMed, Scielo, MedLine, and Embase. Original studies and systematic reviews on lumbar drainage in endoscopic surgeries for pituitary macroadenomas were included, focusing on the prevention of CSF fistulas. Results and Discussion: Lumbar drainage (LD) has shown benefits in reducing CSF fistulas after endoscopic pituitary macroadenoma surgeries, especially in cases of high-flow intraoperative leaks. Although its efficacy is questioned in low-flow leaks, prophylactic LD, combined with reconstruction techniques, can prevent complications, particularly in adenomas with suprasellar extension. Conclusion: Lumbar drainage of CSF is effective in preventing CSF fistulas in pituitary macroadenoma surgeries, especially in cases with suprasellar extension. Its prophylactic use, combined with saline infusion and duroplasty, reduces postoperative complications such as meningitis.