Jaeyoung So1, Hunho Park1, Kyeong-Soo Sung1, Kyu Sung Lee1, Chang-Ki Hong2. 1. Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University of Medicine, 211 Eonju-ro, Gangnamgu, Seoul 135-720, Republic of Korea. 2. Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University of Medicine, 211 Eonju-ro, Gangnamgu, Seoul 135-720, Republic of Korea. Electronic address: yedamin@yuhs.ac.
Abstract
PURPOSE: Various surgical methods to prevent intraoperative and postoperative cerebrospinal fluid (CSF) leaks during transsphenoidal approach (TSA) surgeries have been reported, but surgical techniques to address large dural defects have been less thoroughly investigated in the literature. The authors retrospectively evaluated the usefulness of the sandwich technique using fibrin-coated collagen fleece (TachoSil) to prevent intraoperative CSF leakage from large dural defects in TSA surgery. METHODS: In total, 101 cases of intraoperative CSF leaks were observed among 465 patients who underwent TSA surgery at a single university hospital between 2002 and 2014. Among them, cases with Grade 3 intraoperative CSF leakages and large diaphragmatic/dural defects were reconstructed via the sandwich technique using TachoSil or via the conventional technique using simple intrasellar packing with fat or synthetic materials, and these cases were enrolled in this study. RESULTS: A total of 28 cases with Grade 3 intraoperative CSF leakages were identified and analyzed. The sandwich technique using TachoSil was applied in 13 cases, and the conventional technique was applied in 15 cases. The postoperative CSF leakage was significantly decreased by the sandwich technique as compared to the conventional technique (retrospectively, 0 cases vs. 4 cases (30.8%); P=0.044). CONCLUSION: The sandwich technique using TachoSil can effectively prevent CSF leakage in cases with large dural defects during TSA surgery.
PURPOSE: Various surgical methods to prevent intraoperative and postoperative cerebrospinal fluid (CSF) leaks during transsphenoidal approach (TSA) surgeries have been reported, but surgical techniques to address large dural defects have been less thoroughly investigated in the literature. The authors retrospectively evaluated the usefulness of the sandwich technique using fibrin-coated collagen fleece (TachoSil) to prevent intraoperative CSF leakage from large dural defects in TSA surgery. METHODS: In total, 101 cases of intraoperative CSF leaks were observed among 465 patients who underwent TSA surgery at a single university hospital between 2002 and 2014. Among them, cases with Grade 3 intraoperative CSF leakages and large diaphragmatic/dural defects were reconstructed via the sandwich technique using TachoSil or via the conventional technique using simple intrasellar packing with fat or synthetic materials, and these cases were enrolled in this study. RESULTS: A total of 28 cases with Grade 3 intraoperative CSF leakages were identified and analyzed. The sandwich technique using TachoSil was applied in 13 cases, and the conventional technique was applied in 15 cases. The postoperative CSF leakage was significantly decreased by the sandwich technique as compared to the conventional technique (retrospectively, 0 cases vs. 4 cases (30.8%); P=0.044). CONCLUSION: The sandwich technique using TachoSil can effectively prevent CSF leakage in cases with large dural defects during TSA surgery.
Authors: Herbert Daniel Jiménez Zapata; Víctor Rodríguez Berrocal; Carlos Vior Fernández; Franklin Mariño Sánchez; Alfredo García Fernández Journal: J Neurol Surg B Skull Base Date: 2019-05-28
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