ArticleBMC neurology2026
Clinical predictors of postoperative cerebrospinal fluid leakage following endoscopic endonasal surgery for pituitary neuroendocrine tumors: a retrospective cohort study.
Article in BMC neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivePostoperative cerebrospinal fluid leakage (CSFL) remains a clinically relevant complication following endoscopic endonasal surgery (EES) for pituitary neuroendocrine tumors (PitNETs). This study aimed to identify independent clinical predictors of postoperative CSFL and to facilitate perioperative risk stratification.
methodsWe retrospectively analyzed 302 consecutive patients who underwent EES for PitNETs at a single tertiary center. Preoperative anatomical features, tumor characteristics, pathological subtypes, and intraoperative variables were collected. Given the limited number of postoperative CSFL events, we used penalized logistic regression (Firth correction) with a prespecified parsimonious set of predictors to reduce small-sample bias.
resultsPenalized multivariable analysis (Firth correction) identified fibrous tumor texture (OR 5.13), strong sellar barrier thickness (> 1 mm; OR 0.09), and intraoperative CSFL grade (Kelly grade 1–2: OR 3.69; Kelly grade 3: OR 34.30) as significant independent predictors. ACTH-secreting pathology demonstrated a trend towards association but did not reach statistical significance (OR 4.76; 95% CI 0.89–25.36; P = 0.068).
conclusionsPostoperative CSFL following EES for PitNETs is associated with a distinct set of clinical and anatomical risk factors. Recognition of these predictors may support individualized reconstruction and perioperative decision-making within a risk-stratified intraoperative decision algorithm; the proposed algorithm is exploratory and requires external validation.
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