Abtin Tabaee1, Ameet Kamat, Raj Shrivastava. 1. Department of Otolaryngology, Head and Neck Surgery, Beth Israel Medical Center, New York, New York 10003, USA. atabaee@hotmail.com
Abstract
BACKGROUND: Skull base reconstruction in the setting of revision endoscopic pituitary surgery with intraoperative cerebrospinal fluid (CSF) leak represents a unique challenge. MATERIALS AND METHODS: The demographics and outcomes of four patients undergoing revision endoscopic pituitary surgery with high-volume intraoperative CSF leak are described. The "gasket-seal" technique of sellar repair using bioabsorbable mini-plate is described. RESULTS: The indications for surgery were macroadenoma with suprasellar extension and optic nerve compression in three patients and growth hormone-secreting tumor in one patient with acromegaly. The multilayered reconstruction consisted of autologous fat placed in the tumor cavity followed by reconstruction of the sellar floor with an oversized sheet of either fascia lata or acellular dermal matrix placed over the skull base defect and sunken into the sella with a bioabsorbable mini-plate. One patient experienced postoperative CSF leak on postoperative day 2 that resolved with lumbar drainage alone. All patients were noted to have a well mucosalized sphenoid sinus and were free of CSF leak at last follow-up. CONCLUSION: Sellar reconstruction following endoscopic pituitary surgery represents a technical challenge, especially in revision cases with high-volume intraoperative CSF leak. The early experience with the "gasket-seal" closure using the bioabsorbable mini-plate appears favorable. Lumbar drain may be indicated in patients with postoperative CSF leak. Georg Thieme Verlag KG Stuttgart · New York.
BACKGROUND: Skull base reconstruction in the setting of revision endoscopic pituitary surgery with intraoperative cerebrospinal fluid (CSF) leak represents a unique challenge. MATERIALS AND METHODS: The demographics and outcomes of four patients undergoing revision endoscopic pituitary surgery with high-volume intraoperative CSF leak are described. The "gasket-seal" technique of sellar repair using bioabsorbable mini-plate is described. RESULTS: The indications for surgery were macroadenoma with suprasellar extension and optic nerve compression in three patients and growth hormone-secreting tumor in one patient with acromegaly. The multilayered reconstruction consisted of autologous fat placed in the tumor cavity followed by reconstruction of the sellar floor with an oversized sheet of either fascia lata or acellular dermal matrix placed over the skull base defect and sunken into the sella with a bioabsorbable mini-plate. One patient experienced postoperative CSF leak on postoperative day 2 that resolved with lumbar drainage alone. All patients were noted to have a well mucosalized sphenoid sinus and were free of CSF leak at last follow-up. CONCLUSION: Sellar reconstruction following endoscopic pituitary surgery represents a technical challenge, especially in revision cases with high-volume intraoperative CSF leak. The early experience with the "gasket-seal" closure using the bioabsorbable mini-plate appears favorable. Lumbar drain may be indicated in patients with postoperative CSF leak. Georg Thieme Verlag KG Stuttgart · New York.
Authors: Edward C Kuan; Frederick Yoo; Pratik B Patel; Brooke M Su; Marvin Bergsneider; Marilene B Wang Journal: J Neurol Surg B Skull Base Date: 2017-08-28