Sellar repair with fibrin sealant and collagen fleece after endoscopic endonasal transsphenoidal surgery

Cappabianca, Paolo; Cavallo, Luigi Maria; Valente, Vinicio; Romano, Immacolata; D’Enza, Alfonso Iodice; Esposito, Felice; Divitiis, Enrico de

doi:10.1016/j.surneu.2004.01.016

Cited by 88 publications

(77 citation statements)

References 24 publications

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“…Endoscopic endonasal transsphenoidal surgery (EETS) is generally considered a safe and effective technique for removal of pituitary adenomas and many other parasellar tumors (4,13). Surgical repair of skull base defects during the EETS procedure is an important and necessary step to prevent postoperative complications, and to provide anatomic integrity (23).…”

Section: Introductionmentioning

confidence: 99%

“…Various techniques and materials depending on surgeons' experiences are used for skull base reconstruction to prevent CSF leak (4,9,13,17,28,33,37,40). Intradural and/ or extradural closure of skull base defect and packing of the sella with or without packing of the sphenoid sinus can be the technical options (37).…”

Section: Introductionmentioning

confidence: 99%

“…and/or some form of rigid/semi-rigid buttressing (nasal septum, sphenoid bone, titanium mesh, biodegradable plates or Foley catheter). Usage of vascularized mucosal flaps, dural substitutes and tissue sealants have also been described (1,4,5,9,10,12,13,15,16,17,18,19,21,22,23,27,28,29,33,34,36,37,39,40,41). Even primary suturing of the dural defects has been reported (31).…”

Section: Introductionmentioning

confidence: 99%

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Using an autologous fibrin sealant in the preventing of cerebrospinal fluid leak with large skull base defect following endoscopic endonasal transsphenoidal surgery

Yıldırım

Dursun²,

Özdöl³

et al. 2013

Turkish Neurosurgery

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AIm: Postoperative cerebrospinal fluid (CSF) leak following endoscopic endonasal transsphenoidal surgery (EETS) is associated with increased morbidity and mortality. This prospective study is the first evaluation of using autologous fibrin sealant for preventing postoperative CSF leak and related complications. mAterIAl and methOds: 200 endoscopic endonasal transsphenoidal approaches were included in the study and reviewed retrospectively from September 2010 to June 2012. A total of 55 patients who have large skull base and diafragma sella defects, connected with basal cisterns or ventricles, were chosen for the study. The patients were operated via extended or classical endoscopic endonasal transsphenoidal approach. The skull base has been repaired using AFS combined with multilayer reconstruction in all cases. The incidence of CSF leak as a complication of EETS was analyzed. results:The ages of the patients ranged from 20 to 83 years (mean 49.3 years). There were 25 (46%) male patients and 30 (54%) females. All patients had tumors with suprasellar or parasellar extension. Postoperative CSF leak was determined in 2 patients (3.6%). There were no complications and allergic reactions associated with the use of AFS.COnClusIOn: Using of AFS combined with multilayer reconstruction technique is a safe and effective method to prevent CSF leak in large defects following EETS.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Using an autologous fibrin sealant in the preventing of cerebrospinal fluid leak with large skull base defect following endoscopic endonasal transsphenoidal surgery

Yıldırım

Dursun²,

Özdöl³

et al. 2013

Turkish Neurosurgery

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“…Most surgeons use autologous tissues such as muscle, fat, and fascia, 5,8,10,18,19 whereas a few use synthetic materials, including a combination of Gelfoam and collagen fleece, 4 Vicryl patches, 17 and polyester-silicone dural substitute, 3 to fill or close the sella turcica after tumor removal. The use of autologous grafting usually necessitates a separate incision, prolongs operative time, causes additional discomfort to the patient, and produces abdominal and thigh scars that can be cosmetically unappealing.…”

Section: Discussionmentioning

confidence: 99%

Simple closure following transsphenoidal surgery

Couldwell¹,

Kan²,

Weiss³

2006

FOC

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✓ The most common nonendocrine complication after transsphenoidal surgery is cerebrospinal fluid (CSF) leak. Many neurosurgeons have advocated the routine reconstruction of the floor of the sella turcica using autologous fat, muscle, fascia, and either cartilage or bone after transsphenoidal surgery to prevent postoperative CSF fistulas. However, the use of autologous grafting requires a second incision, prolongs operative time, and adds to the patient's postoperative discomfort. In addition, the presence of sellar packing may interfere with the interpretation of postoperative images. To avoid these disadvantages, the authors suggest that routine sellar reconstruction or closure after transsphenoidal surgery is unnecessary unless an intraoperative CSF leak is encountered. The incidence of postoperative CSF leakage in the patients reported on in this series is no higher than that reported by others, and no other complications such as pneu-matocele have been encountered in approximately 2700 patients in whom no intraoperative CSF leak was encountered. The authors conclude that routine closure of the floor of the sella turcica or sphenoid is unnecessary in the absence of intraoperative CSF leak.

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“…Preoperatively, LDs assist in delivering the suprasellar portions to be surgically accessible in cases of macroadenomas, especially in cases where the sellae is small or when there is a bottleneck constriction at the diaphragm level [23]. Other authors may insert a LD preoperatively as they may anticipate CSF leak postoperatively [24].…”

Section: Indicationsmentioning

confidence: 99%

Perioperative Cerebrospinal Fluid Diversion Utilizing Lumbar Drains in Transsphenoidal Surgery

Shah¹

2013

J Neurol Disord

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Sellar repair with fibrin sealant and collagen fleece after endoscopic endonasal transsphenoidal surgery

Cited by 88 publications

References 24 publications

Using an autologous fibrin sealant in the preventing of cerebrospinal fluid leak with large skull base defect following endoscopic endonasal transsphenoidal surgery

Using an autologous fibrin sealant in the preventing of cerebrospinal fluid leak with large skull base defect following endoscopic endonasal transsphenoidal surgery

Simple closure following transsphenoidal surgery

Perioperative Cerebrospinal Fluid Diversion Utilizing Lumbar Drains in Transsphenoidal Surgery

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