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DOI: 10.1055/s-0037-1600767
Systematic Endoscopic Endonasal Approach to Pituitary Adenomas. Reconstruction of Skull Base with Pedicle Mucoperichondrial Flap versus Free Abdominal Fat Graft for Patients with Incidental Rupture of Sellar Diaphragma
Publication History
Publication Date:
02 March 2017 (online)
The authors presented their casuistic of 120 endoscopic endonasal approach for resection of pituitary adenomas, and studied the best management of intraoperative CSF leak due to sellar diaphragma rupture. Thirty-four patients with pituitary macroadenomas showed intraoperative CSF leak, 28.33%, and they were treated according to the groups. 18 patients were treated with insertion of abdominal fat inside the sella, sellar Porex, and hydrogel seal (Duraseal, Covidien, USA) and 16 were treated with insertion of Oxcelulose pieces and mucoperichondrial flap rotation covering the overture and DuraSeal over the flap. All of them received lumbar drainage for 5 days. The CSF leak was solved in 16 of 18 cases (first group), 88.88%, 1 case of meningitis was observed and treated, and the 2 patients with persistent CSF leak were treated with rotation of mucoperichondrial flap in a second operation, with complete resolution of the leak. The second group, 15 patients in 16 became without CSF leak in the postoperative course, 93.75% of resolution, and 1 case was reoperated with use of fascia lata graft and abdominal fat free graft placed over the mucoperichondrial flap and DuraSeal, and 14 days of lumbar drainage. No meningitis was verified in this second group even in the patient with recurrent CSF leak. We conclude that it is possible to close the sellar floor using the both methods, and the pedicle mucoperichondrial flap rotation seems to be statistically better than the free abdominal fat insertion, but statistically the results were not significant due to reduced n in both groups.