Eui Hyun Kim1,2,3, Ju Hyung Moon1,2,3, Sun Ho Kim1,2,3. 1. Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea. 2. Pituitary Tumor Center, Yonsei University College of Medicine, Seoul, Republic of Korea. 3. Yonsei Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Abstract
BACKGROUND: During transsphenoidal surgery (TSS) for a pituitary adenoma with a large suprasellar extension, cerebrospinal fluid (CSF) leakage commonly develops from a defect in the arachnoid recess or the arachnoid membrane. OBJECTIVE: To evaluate the usefulness of a newly developed clipping technique for the repair of intraoperative CSF leakage. METHODS: Between September 2012 and November 2016, 698 patients with pituitary adenoma were operated on with TSS. Intraoperative CSF leakage was encountered in 301 patients (43.1%). The clipping technique was used to repair CSF leakage in 144 patients: from the arachnoid recess in 100 patients and from the arachnoid membrane in 44 patients. The clipping technique used titanium clips and a newly designed clip applier. We evaluated anterior pituitary function of the patients whose CSF leakage was closed by clipping, and compared this with function in another patient group treated with different repair techniques. RESULTS: We successfully applied clip technique in 140 out of 144 patients. This clipping technique was faster and easier for repairing CSF leakage than our previously published suture technique. In our early series, 4 patients developed unexpected CSF rhinorrhea after TSS. We found no difference in anterior pituitary function between a clipping group and others. Although titanium clip was identified on postoperative MRI, its metallic scattered artifact was very minimal and did not hinder the detection of possible remnant and recurrent tumors. CONCLUSION: This clipping technique is a very simple and reliable method for repairing intraoperative CSF leakage when properly applied with caution.
BACKGROUND: During transsphenoidal surgery (TSS) for a pituitary adenoma with a large suprasellar extension, cerebrospinal fluid (CSF) leakage commonly develops from a defect in the arachnoid recess or the arachnoid membrane. OBJECTIVE: To evaluate the usefulness of a newly developed clipping technique for the repair of intraoperative CSF leakage. METHODS: Between September 2012 and November 2016, 698 patients with pituitary adenoma were operated on with TSS. Intraoperative CSF leakage was encountered in 301 patients (43.1%). The clipping technique was used to repair CSF leakage in 144 patients: from the arachnoid recess in 100 patients and from the arachnoid membrane in 44 patients. The clipping technique used titanium clips and a newly designed clip applier. We evaluated anterior pituitary function of the patients whose CSF leakage was closed by clipping, and compared this with function in another patient group treated with different repair techniques. RESULTS: We successfully applied clip technique in 140 out of 144 patients. This clipping technique was faster and easier for repairing CSF leakage than our previously published suture technique. In our early series, 4 patients developed unexpected CSF rhinorrhea after TSS. We found no difference in anterior pituitary function between a clipping group and others. Although titanium clip was identified on postoperative MRI, its metallic scattered artifact was very minimal and did not hinder the detection of possible remnant and recurrent tumors. CONCLUSION: This clipping technique is a very simple and reliable method for repairing intraoperative CSF leakage when properly applied with caution.
Authors: Danyal Z Khan; Ahmad M S Ali; Chan Hee Koh; Neil L Dorward; Joan Grieve; Hugo Layard Horsfall; William Muirhead; Thomas Santarius; Wouter R Van Furth; Amir H Zamanipoor Najafabadi; Hani J Marcus Journal: Pituitary Date: 2021-05-10 Impact factor: 4.107