Combined Synthetic and Nonautologous Gasket Seal for Skull Base Repair after Endoscopic Transsphenoidal Surgeries

Background: Transsphenoidal surgery (TSS) is a highly prevalent surgery that in many cases requires skull base repair. This is particularly important in the setting of intraoperative cerebrospinal fluid (CSF) leak. Multiple repair techniques exist for repair of CSF leaks after TSS. The gasket seal is often employed for CSF leak repair and commonly utilizes autologous tissue for reconstruction that may lead to donor site morbidity. We present a single intuition's experience utilizing a combined synthetic and non-autologous gasket seal for repair of CSF leaks following TSS.

Objectives: To report the use of combined synthetic and non-autologous gasket seal for skull base repair after TSS.

Methods: This retrospective case series reviewed TSS surgeries at a single institution. Demographics of the patient population, readmission rate, perioperative complications, postoperative leak rates, skull base repair technique, and pathology were all recorded for patients repaired with a combined synthetic/non-autologous gasket seal (decellularized porcine small intestinal submucosa combined with Poly-D, l-lactic acid (PDLLA) resorbable plate) during TSS.

Results: A total of 13 patients (31% female) with an average age of 45 and BMI of 30.6 kg/m² underwent TSS with combined synthetic/non-autologous gasket seal repair over the past 12 months. Pathology was consistent with 11 pituitary adenomas (84.8%), 1 Rathke cleft cyst (7.6%), and 1 craniopharyngioma (7.6%). 6 of 11 (55%) pituitary adenomas resected were secreting tumors. All patients demonstrated intraoperative CSF leak after tumor resection. Average tumor size was 2.29 cm. Combined synthetic/non-autologous gasket seal showed no evidence of postoperative leak in any patient post operatively at most recent follow up.

Conclusion: A combined synthetic/non-autologous gasket seal is a unique and efficient skull base repair using readily available products that has potential to limit donor site morbidity from autologous graft harvest. No patients demonstrated postoperative leak. This study serves as a pilot on the efficacy of this technique while longer term follow up and cost efficacy will be necessary to fully determine its utility.

Fig. 1 Gasket seal repair of CSF leak utilizing decellularized porcine small intestinal submucosa combined with PDLLA resorbable plate.