INTRODUCTION: Our aim was to evaluate the routine use of a pedicled nasoseptal flap (NSF) as a primary repair for intra-operative CSF leaks compared with fat/fascia lata graft and lumbar drain insertion by performing a retrospective review of elective patients undergoing primary trans-sphenoidal surgery from January 2008 to present. MATERIALS AND METHODS: A retrospective review of consecutive primary elective trans-sphenoidal cases for sellar pathology was undertaken. Prior to September 2009, microscopic trans-sphenoidal surgery (MTSS) was performed in 40 cases and since then endoscopic trans-sphenoidal surgery (ETSS) was performed in 100 cases. RESULTS AND ANALYSIS: In the MTSS group, intra-operative CSF leaks were repaired with fat graft, tisseal and lumbar drain insertion. Intra-operative leaks in the ETSS group were routinely repaired with a pedicled NSF. Post-operative CSF leak rates were 12.5% in the MTSS and 3% in the ETSS groups, respectively. Three patients in the ETSS group developed a post-op CSF leak. All of these patients underwent surgery for craniopharyngiomas. This group had subsequent endoscopic repairs and were managed with repositioning of the NSF. CONCLUSION: The advent of the pedicled NSF conveys a significant advantage in preventing post-operative CSF leak, decreasing the morbidity associated with lumbar drain insertion and reduces the length of hospital stay.
INTRODUCTION: Our aim was to evaluate the routine use of a pedicled nasoseptal flap (NSF) as a primary repair for intra-operative CSF leaks compared with fat/fascia lata graft and lumbar drain insertion by performing a retrospective review of elective patients undergoing primary trans-sphenoidal surgery from January 2008 to present. MATERIALS AND METHODS: A retrospective review of consecutive primary elective trans-sphenoidal cases for sellar pathology was undertaken. Prior to September 2009, microscopic trans-sphenoidal surgery (MTSS) was performed in 40 cases and since then endoscopic trans-sphenoidal surgery (ETSS) was performed in 100 cases. RESULTS AND ANALYSIS: In the MTSS group, intra-operative CSF leaks were repaired with fat graft, tisseal and lumbar drain insertion. Intra-operative leaks in the ETSS group were routinely repaired with a pedicled NSF. Post-operative CSF leak rates were 12.5% in the MTSS and 3% in the ETSS groups, respectively. Three patients in the ETSS group developed a post-op CSF leak. All of these patients underwent surgery for craniopharyngiomas. This group had subsequent endoscopic repairs and were managed with repositioning of the NSF. CONCLUSION: The advent of the pedicled NSF conveys a significant advantage in preventing post-operative CSF leak, decreasing the morbidity associated with lumbar drain insertion and reduces the length of hospital stay.
Authors: Tara J Wu; Angela Chen; Christine Wells; Anthony P Heaney; Marvin Bergsneider; Marilene B Wang Journal: J Neurol Surg B Skull Base Date: 2020-09-10
Authors: Christina Dorismond; Griffin D Santarelli; Brian D Thorp; Adam J Kimple; Charles S Ebert; Adam M Zanation Journal: J Neurol Surg B Skull Base Date: 2020-08-07
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
Authors: James Barger; Matthew Siow; Michael Kader; Katherine Phillips; Girish Fatterpekar; David Kleinberg; David Zagzag; Chandranath Sen; John G Golfinos; Richard Lebowitz; Dimitris G Placantonakis Journal: Surg Neurol Int Date: 2018-02-14