Acellular Dermal Allograft for Sellar Repair after Transsphenoidal Approach to Pituitary Adenomas

Abstract

Objectives Our practice has transitioned from using fat autograft to acellular dermal matrix (AlloDerm, LifeCell Corp, Woodlands, Texas, USA). We present the largest series to our knowledge of AlloDerm for sellar floor repair after transsphenoidal approach to pituitary adenoma and compare rates of postoperative cerebrospinal fluid (CSF) leak with an earlier cohort of patients whose CSF leaks were repaired with fat autograft. Design This is a retrospective cohort study comparing sellar repair with fat autograft versus inlay Alloderm between the years 2003 and 2012. The primary end point was postoperative CSF leak. Results A total of 429 patients (368 primary; 83 revision operations) without intraoperative lumbar drainage were included. A total of 18 postoperative CSF leaks were observed (3.9%). Intraoperative CSF leak occurred in 160 cases (35.5%). Among this subset of patients with intraoperative CSF leak, 95 underwent repair with AlloDerm and 46 underwent repair with fat autograft, with postoperative CSF leak rates of 8.4% and 15.2%, respectively (p = 0.34, chi-square test); 19 patients underwent repair with other techniques or no repair at all, with postoperative leak rate of 0%. Conclusions AlloDerm is an effective alternative to fat autograft in cases of low-flow CSF leak following transsphenoidal resection of pituitary adenoma.

ICAR: endoscopic skull‐base surgery

“…Materials frequently used in reconstruction include autologous fat, fascia lata, septal bone, and cartilage, as well as all native sphenoid sinus mucosa, free mucosal grafts, and pedicled NSFs. Allografts frequently used include Alloderm (Allergan, Branchburg, NJ), absorbable and nonabsorbable plates, and titanium mesh, as well as collagen matrix materials, all typically in multilayered fashion . Various types of tissue glues are also included in many of the reconstruction protocols.…”

Collagen matrix as an inlay in endoscopic skull base reconstruction

“…Gaynor et al . compared transsphenoidal pituitary surgery reconstructions using acellular dermal matrix and fat graft in the event of intra-operative CSF leak, and found equivalent success between them 14 . There were 160 cases of intra-operative CSF leak, with 8.4 per cent in the acellular dermal matrix group versus 15.2 per cent in the fat graft group with reported post-operative leak ( p = 0.34).…”

Utility of the Nasoseptal “Rescue” Flap Approach: Analysis of 125 Consecutive Patients and Implications for Routine Transsphenoidal Surgery

“…9 Furthermore, before the innovation of the NSF, many small and large reconstructions were performed with fascia lata, fat, synthetic substitutes, nonvascularized mucosal grafts, and glues, highlighting that employment of the NSF is not always necessary. [18][19][20][21][22] The trend that many are "over working the workhorse," and overusing the NSF was further highlighted in a recent survey of the NASBS in which 50% of surgeons reported used the NSF for low-flow intraoperative CSF leaks in routine transsphenoidal surgery, and another 15% even used it when no leak was encountered. 23 We suspect that this may be related to the technique of routinely harvesting the NSF upfront, which then leads to the conundrum of what to do with a raised NSF at the end of a procedure in cases where an NSF may not actually be needed.…”