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

Abstract

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.

Fat in the Fossa and the Sphenoid Sinus: A Simple and Effective Solution to CSF Leaks in Transsphenoidal Surgery. Cohort Study and Systematic Review

“…This is supported by recent studies that have also found low rates of postoperative CSF leaks with a fat-only technique, along with little need for lumbar drainage or reoperation. 9 13 We also demonstrated a reduction in mean postoperative hospital stay. Despite our relatively long mean length of stay of 4 to 6 days in the no postoperative CSF leak cohort, the postoperative needs for patients varied from inpatient ophthalmology for visual assessment or endocrine input for diabetes insipidus.…”

“…This yielded 33 articles for inclusion in our study ( Table 6 ). 4 6 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 One article had two separate groups of TSS surgeries 12 producing a total of 34 sets of patients, totaling 9,141 patients altogether. The rate of postoperative CSF leak varied between 0 and 14.6%.…”

Effects of Staged Nursing Care on Neuroendoscopic Transsphenoidal Pituitary Adenoma Resection and Postoperative Complications

“…Presently, pituitary tumors are mainly treated surgically. Due to the rapid development of minimally invasive techniques and surgical instruments in China [4], the application of neuro endoscopy in transsphenoidal surgery has also increased. When compared with traditional craniotomies, neuroendoscopic transsphenoidal surgery causes less trauma to the patient's body, so postoperative recovery is more rapid, making it a more suitable procedure for elderly or frail patients [5].…”

Closure strategy for endoscopic pituitary surgery: Experience from 3015 patients

“…In case of high-flow leak, the objective is to achieve a strong and persistent watertight closure with an intrasellar packing. Some authors recommend to use intrasellar fat and glue (33,57,(71)(72)(73)(74)(75) with low rates of postoperative leak. In our experience, we prefer to use a fascia and muscle graft to achieve a two-layer intrasellar repair: the fascia is introduced into the sella and applied superiorly to cover the entire defect, in order to recreate a new diaphragm; the muscle graft is then positioned in the intrasellar compartment.…”