Complications after craniopharyngioma surgery

Craniopharyngioma is a very common disease in daily life. Once it worsens, it will cause great harm to people's bodies. Therefore, many people will choose surgery for treatment. This type of surgery will have many complications. Cerebrospinal fluid rhinorrhea is a particularly common one. It will cause cerebrospinal fluid filling and lead to intracranial damage. Therefore, people need to know more about this and learn prevention methods as early as possible.

1. Postoperative complications of craniopharyngioma: cerebrospinal fluid rhinorrhea

The skull is a sealed cavity that encloses the brain tissue, similar to the inner and outer tubes of a bicycle. There is cerebrospinal fluid between the brain tissue and the skull. If there is a gap in the skull, cerebrospinal fluid will flow out of the nasal cavity. In other words, the outer tire is broken, but the inner tube is fine. At this time, the damage is not great and this is the best time to deal with it. If it is not dealt with, it will lead to catastrophic consequences.

2. What are the hazards of cerebrospinal fluid rhinorrhea?

After cerebrospinal fluid leaks from the nose, the brain tissue is connected to the outside world, and bacteria from the outside world will retrograde into the skull, destroy brain cells, and cause intracranial infection. This is what we often call encephalitis and meningitis. That is to say, the outer tire is damaged, the inner tire loses its protection and becomes damaged. At this time, the damage is huge!

3. What are the clinical manifestations of cerebrospinal fluid rhinorrhea?

(1) Clear liquid flows out of the nasal cavity, which can be unilateral or bilateral, and worsens when lowering the head or turning over.

(2) You feel salt water flowing from your throat into your mouth. Both or one of the above symptoms occurs.

Is nasal discharge definitely cerebrospinal fluid rhinorrhea? It is necessary to rule out nasal discharge caused by cold or allergy!

Some people may have nasal discharge due to colds or nasal allergies. This discharge is usually thick and accompanied by cold symptoms, and is usually easy to eliminate. However, if clear nasal discharge occurs, it needs to be differentiated from cerebrospinal fluid rhinorrhea. Determine whether there are any factors that may cause cerebrospinal fluid rhinorrhoea, determine whether the patient has cold or allergy symptoms, collect the flowing fluid, and do a biochemical test, which can usually confirm the diagnosis. If necessary, cranial imaging examinations such as head CT, MRI, cerebrospinal fluid imaging, and CT cisternography are required. We encountered a patient earlier and it was finally confirmed to be allergic rhinitis.

Why does cerebrospinal fluid rhinorrhea occur?

(1) In some patients, the tumor grows in the sella turcica, causing the sella turcica to expand, compressing the bone of the sella turcica floor, and even invading the sphenoid sinus, directly leading to cerebrospinal fluid rhinorrhea, which is called spontaneous cerebrospinal fluid rhinorrhea. In other words, the things that grew on the inner tube directly destroyed the outer tube.

(2) During the craniotomy, the frontal sinus was opened but not sealed tightly, resulting in cerebrospinal fluid rhinorrhea. That is to say, when repairing the inner tube, the outer tube needs to be pried off, and the outer tube is damaged in the process of prying off. This is extremely rare

(3) The tumor grows into the sella turcica, the sella turcica enlarges, the tumor is tough, and the anterior wall of the sphenoid sinus blocks the surgical field of view, making it impossible to remove the tumor under direct vision. Only by grinding away the tuberculum sellae can the tumor be completely removed. That is to say, the tumor grows from the inner tube into the outer tube in the shape of a protrusion, and is tightly adhered to the outer tube. In order to achieve the purpose of completely removing the tumor, part of the outer tube has to be removed.

(4) Intrasellar craniopharyngioma. After transsphenoidal surgery, another craniotomy is required. The tuberculum sellae needs to be removed, and the sphenoid sinus has been destroyed once. Cerebrospinal fluid rhinorrhea occurred postoperatively. This means that the outer tire has been damaged and repaired, and then it is damaged again and then repaired, which can easily cause nasal leakage. This is common.

5. Will patients who have craniopharyngioma surgery definitely have cerebrospinal fluid rhinorrhea? What are the ways to prevent it?

Only a small number of patients will experience cerebrospinal fluid rhinorrhea. After the tumor is completely removed, the damaged skull base will be repaired by filling it with bone wax or by taking autologous muscle and using ear-brain glue to glue it together.