Frequency of Cerebrospinal Fluid (CSF) Rhinorrhea Following Endoscopic Transsphenoidal Pituitary Macroadenoma Excision at Tertiary Care Hospital

Background: Cerebrospinal fluid (CSF) rhinorrhea remains a significant postoperative complication after endoscopic transsphenoidal surgery for pituitary macroadenomas. Early identification and prevention are essential to reduce morbidity. Objective: To determine the frequency of CSF Rhinorrhea following endoscopic transsphenoidal pituitary macroadenoma excision at public tertiary care hospital. Material and Methods: The current cross-sectional descriptive study was conducted during 20 January, 2025 to 15 May, 2025 at the Department of Neurosurgery, Liaquat National Hospital & Medical College, Karachi. Total 143 participants of both genders having age of 18 to 60 years patients diagnosed with pituitary macroadenoma and underwent endoscopic endonasal transsphenoidal surgery were enrolled. Patients having recurrent tumors or whose have severe co-morbidities were excluded from this study. The collected data was entered, compiled and analyzed by using SPSS-27and taking p-value < 0.05 as statically significant. Results: The mean age was 41.99 ± 11.39 years (range: 18–60), with 97 (67.8%) males and 46 (32.2%) females. Obesity (BMI > 30 kg/m²) was noted as 45(31.45%) of patients. Hypertension was present in 24(16.8%), diabetes mellitus 33(23.1%) were noted. Headache 140(97.9%) and vision loss 136(95.1%) were the most common presenting symptoms, followed by fatigue 35(24.5%), dizziness 17(11.9%), and decreased libido 10(7.0%). Maximum patients 12(22.2%) observed for CSF rhinorrhea with tumor size as 26-40(mm) compared with 56-70 (mm) group as 8(30.8%) with statistically significant p-value as 0004. Conclusion: Larger pituitary tumors were significantly associated with a higher risk of postoperative CSF rhinorrhea. Careful surgical planning and reconstruction are essential in such cases to reduce this complication.