Sellar reconstruction with resorbable vicryl patches, gelatin foam, and fibrin glue in transsphenoidal surgery: a 10-year experience with 376 patients

Abstract

Closure of the sella turcica with a synthetic absorbable vicryl patch, gelatin foam, and fibrin glue after transsphenoidal surgery is safe and very effective in preventing postoperative CSF fistulas. The use of this technique obviates the need for a second surgical incision and shortens the operating time. Because of the progressive resorption of the substitute material, the interpretation of postoperative magnetic resonance studies was not significantly hindered.

Perioperative Cerebrospinal Fluid Diversion Utilizing Lumbar Drains in Transsphenoidal Surgery

“…Black et al reported a higher incidence of postoperative CSF leak in macroadenomas (4.2%), particularly those with suprasellar extension, than microadenomas (0.9%). On the other hand, others did not observe any correlation between pituitary adenoma size and the likelihood of postoperative leak [13].…”

“…Various studies have investigated the factors that contribute to persistent CSF leak [2,[11][12][13]. Black et al reported a higher incidence of postoperative CSF leak in macroadenomas (4.2%), particularly those with suprasellar extension, than microadenomas (0.9%).…”

“…As revision surgery usually occurs to remove tumor that was not easily accessible in the first surgery, it can often involve aggressive dissection along the diaphragma sellae which places the patient in greater risk for CSF leak. Postoperative CSF leaks are more commonly seen when a visible CSF leak is seen during surgery than when a leak is not seen intraoperatively (2.9% vs 0.0%) [13]. Furthermore, intraoperative CSF leak has an average incidence of approximately 40% [3,11,14,15].…”

One-Piece Modified Gasket Seal Technique

“…As displayed in the literature, numerous options for skull base reconstruction after endoscopic endonasal surgery, including both autologous and synthetic materials, have been described to date. [1][2][3][4][5][6][7][8][9][10][11] The primary goal of skull base reconstruction, regardless of surgical technique, includes watertight separation of the intracranial and sinonasal cavities. Failure to achieve these reconstructive goals can result in life-threatening complications such as CSF leak, meningitis, or tension pneumocephalus.…”

“…[1][2][3][4][5][6][7][8][9][10][11] Many of these methods evolved from lessons learned from microscopic transsphenoidal approaches and incorporate a wide a range of surgical materials, including autologous fascia, muscle, fat, and bone, as well as various synthetic materials and tissue sealants for multilayered closure. The goal of reconstruction is to reduce the incidence of postoperative complications, such as infection and cerebrospinal fluid (CSF) leak.…”