Abdominal Fat Graft for Sellar Reconstruction: Retrospective Outcomes Review and Technical Note

Roca, Elena; Penn, David L.; Safain, Mina G.; Burke, William; Castlen, Joseph P.; Laws, Edward R.

doi:10.1093/ons/opy219

Cited by 37 publications

(38 citation statements)

References 56 publications

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“…Although, this is a common site for many neurosurgeons and no incision siterelated complications occurred in the present study, some authors suggest a periumbilical incision for better cosmetic results (►Table 2). 13,26 Several authors reported the routine use of CSF diversion procedures, including lumbar drainage or lumbar fenestration, 27,28 when intraoperative CSF leaks occur. However, due to the very low incidence rates of postoperative CSF leaks in the present study and other previously reported studies, 9,13 as well as the potential to aggravate an ascending infection caused by lumbar drainage if postoperative CSF rhinorrhea is present, routine use of any CSF diversion technique was not performed.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Numerous techniques including autologous grafts or artificial materials have been described for sellar reconstruction to prevent postoperative CSF leaks. [9][10][11][12][13][14] Among the techniques, using fat and/or fascia grafts harvested from the patient's abdomen or thigh has been suggested in many studies as an important effective method to control CSF leaks, resulting in avoidance of lumbar drain, and long-term bedrest with decreased hospital stays. 9,13,15 In the present study, we report a single surgeon's experience with EETSA for pituitary adenomas and the clinical results of sellar floor reconstruction using autologous abdominal fat grafts for intraoperative CSF leaks.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Experience in Prevention of Postoperative CSF Leaks Using Abdominal Fat Grafts in Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas

Ahn

Park

Kim

et al. 2020

J Neurol Surg B Skull Base

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Objective Cerebrospinal fluid (CSF) leaks are the most common complication during endonasal endoscopic transsphenoidal approach (EETSA) and prevention of postoperative CSF leaks is critical. In this study, we report a single surgeon's experience of sellar floor reconstruction using abdominal fat grafts for prevention of postoperative CSF leaks in EETSA for pituitary adenomas. Design This study is presented as case series with retrospective chart review. Setting Present study was conducted at tertiary referral center. Participants A total of 216 patients who underwent surgery via EETSA for pituitary adenomas between 2008 and 2018 at our institution were evaluated. When an intraoperative CSF leak occurred, sellar floor reconstruction was performed using a fat graft harvested from the abdomen via a 2-cm skin incision. Main Outcome Measures Primary outcome and measures of this study was postoperative CSF leaks. Results A total of 53 patients showed intraoperative CSF leaks (24.5%) and 2 patients showed postoperative CSF leaks (0.93%). There were no postoperative CSF leaks in any patients who showed intraoperative CSF leaks and received sellar floor reconstruction using fat grafts. There were also no postoperative CSF leaks in 12 patients who received preventative sellar floor reconstruction using fat grafts due to extensive arachnoid herniation without intraoperative CSF leaks. However, there were two postoperative CSF leaks in patients who did not show intraoperative CSF leaks and did not receive sellar floor reconstruction. Conclusion The effectiveness of sellar floor reconstruction using abdominal fat grafts in patients receiving EETSA for pituitary adenoma was reported. We suggest that identification of intraoperative CSF leaks is important and preventive sellar floor reconstruction without evidence of intraoperative CSF leaks can also be beneficial.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical Experience in Prevention of Postoperative CSF Leaks Using Abdominal Fat Grafts in Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas

Ahn

Park

Kim

et al. 2020

J Neurol Surg B Skull Base

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“…11,12 In the case of an intraoperative CSF leak however, it appears to be generally accepted throughout the literature that sellar floor reconstruction should take place to prevent postoperative meningitis. 13 Other techniques to try and prevent recurrence such as instillation of alcohol into the pituitary fossa have failed to show an improvement in recurrence rates, and will not be addressed in this study. 5…”

Section: Introductionmentioning

confidence: 97%

Relationship between Recurrence Rates of Rathke's Cleft Cysts and Surgical Approaches to Sellar Reconstruction

Limb

King

2020

J Neurol Surg B Skull Base

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Study Objective The main purpose of this article is to address the question of whether reconstructing the sellar floor following Rathke's cleft cyst excision results in increased rates of recurrence. Methods and Design A retrospective case series was compiled from medical records and radiological investigations at a single institution over a time period spanning 25 years. Episodes of cyst recurrence were determined from magnetic resonance imaging scans and outpatient encounters. Details regarding surgical procedure and techniques were obtained from operation notes. Perioperative morbidity was also recorded. Results Twenty-three adult patients were treated surgically for a Rathke's cleft cyst at the study institution between 1992 and 2017. The overall cyst recurrence rate was 48%, with 39% of all patients requiring redo surgery within the timeframe of the study. The mean time to redo surgery for recurrence was 4 years. Cyst recurrence rates were 57% postmicroscopic procedures, and 26% postendoscopic procedures (p = 0.148). In the nonreconstructed group, the recurrence rate was 17%, and in the reconstructed group the recurrence rate was 41% (p = 0.3792). Complications arising after nonreconstructive procedures were delayed cerebrospinal fluid rhinorrhea, pneumocephaly, and multiple episodes of meningitis. All these patients required return to theater for secondary reconstruction of the pituitary fossa floor. Conclusion The results of this small study suggest that reconstruction of the sellar floor, and microscopic rather than endoscopic techniques, may be associated with a higher rate of Rathke's cleft cyst recurrence. However, these trends did not reach statistical significance. Patients undergoing nonreconstructive procedures may be more prone to certain postoperative complications.

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“…The frequency of postoperative CSF leaks depends on many factors as the technique used for reconstruction of the sellar floor and the skull base bony defect, and has been observed in as many as 5 to 75% of cases (Gardner et al, 2008a,b;Stippler et al, 2009;Greenfield et al, 2010). CSF leaks can lead to complications such as infection and pneumoencephalus, which may lead to further comorbidities, longer recovery times and increased hospital costs (Conger et al, 2018;Roca et al, 2018).…”

mentioning

confidence: 99%

“…Different techniques and materials have been reported in the literature for reconstruction of these skull base defects including the use of fat grafts, autologous muscle, fascia lata, vascularized mucosal flaps, non-vascularized autografts, and different synthetic materials (Conger et al, 2018;Roca et al, 2018). They include bio-absorbable implants as collagen sponges (Kelly et al, 2001), dura mater substitute (Sandoval-Sánchez et al, 2012;Al-Asousi et al, 2017), fibrin glue, Polyethylene glycol (PEG) hydrogel dural sealant (Cosgrove et al, 2007;Burkett et al, 2011), polydioxanone plates and non-absorbable implants as porous polyethylene plates and titanium mesh (Al-Asousi et al, 2017).…”

mentioning

confidence: 99%

Bilaminar Chitosan Scaffold for Sellar Floor Repair in Transsphenoidal Surgery

Ramos-Zúñiga

López-González

Segura-Durán

2020

Front. Bioeng. Biotechnol.

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Background: Endoscopic endonasal transsphenoidal surgery (EETS) is a standard technique used to approach sellar tumors. It is relatively safe, minimally invasive and carries a low risk of complications. However, one of the common complications reported with this technique is CSF leakage which causes morbidity, an increase in recovery time and hospital costs. This complication usually occurs from violation of the diaphragma sellae and a defect in the structures of the sellar floor or incomplete repair. In this article we report the first case with the use of a novel bilaminar chitosan scaffold which can be potentially used in the repair of the sellar floor, primarily aiming to the bony part of this structure. Case Presentation: After a personalized design employing a tissue engineering strategy, we reconstructed the sellar floor in a 65-year-old woman who had undergone EETS for a pituitary adenoma with progressive bilateral visual loss. To repair the bony defect of the sellar floor, we used a novel bilaminar chitosan scaffold. The patient had an unremarkable postoperative course with no evidence of CSF leak. The polymer was well tolerated without toxicity, infection or complications. After 2 years of follow up the patient remains neurologically intact, and in good endocrinological status. Conclusion: This is the first report of the use of this biomaterial and its biocompatibility in a clinical setting for the repair of the sellar floor during EETS. Our experience with chitosan bilaminar scaffold and in several preclinical studies in the literature have demonstrated good biocompatibility and effective bioengineered bone regeneration due to its excellent osteoconductive properties, this study pretends to be one landmark for further clinical research and larger case series with the use of this personalized tissue engineering materials in order to see they real efficacy to increase the surgeon armamentarium.

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Abdominal Fat Graft for Sellar Reconstruction: Retrospective Outcomes Review and Technical Note

Abstract: Minimizing postoperative CSF leaks following endonasal anterior skull base surgery is important to decrease morbidity and to avoid a prolonged hospital stay. We present an evolved technique of abdominal fat grafting that is effective and safe and includes minimal morbidity and expense.

Cited by 37 publications

References 56 publications

Surgical Experience in Prevention of Postoperative CSF Leaks Using Abdominal Fat Grafts in Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas

Surgical Experience in Prevention of Postoperative CSF Leaks Using Abdominal Fat Grafts in Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas

Relationship between Recurrence Rates of Rathke's Cleft Cysts and Surgical Approaches to Sellar Reconstruction

Bilaminar Chitosan Scaffold for Sellar Floor Repair in Transsphenoidal Surgery

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