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CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(02): 334-337
DOI: 10.1055/s-0044-1787088
Case Report

Suturing and Closure of Diaphragma Sella to Augment Sellar Floor Repair after Endonasal Endoscopic Resection of Large Pituitary Adenoma

Sushanta K. Sahoo
1   Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Murali K. Bethanbhatla
1   Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Sivashanmugam Dhandapani
1   Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract

Background Large pituitary adenoma often pushes the diaphragma sella and extends to the suprasellar compartment. The thinned out diaphragma may get opened during endonasal endoscopic surgery and pose high risk for cerebrospinal fluid (CSF) leak. Such larger defects are difficult to plug with fat graft that tends to slip in to the subarachnoid space. Here, we describe a unique technique of closure of diaphragma sella that augment repair of the skull base in such cases.

Materials and Method The free edge of diaphragma sella was sutured with the anterior tuberculum sella dura in five cases of large pituitary adenoma that needed extra arachnoidal resection. Suturing was done with 6-0 prolene using endoscopic needle holder that converted a large diaphragm defect in to a smaller arachnoid rent and was easily plugged with fat graft.

Result None of these patients had postoperative CSF leak.

Conclusion Though technically difficult, direct repair of the diaphragma sella is possible. This augments the skull base reconstruct and effectively reduces the chances of postoperative CSF leak.

Keywords

CSF leak - diaphragma sella - neuroendoscopy - pituitary tumor - sellar floor

Authors' Contributions

S.K.S.: Concept and design, collection of data, manuscript drafting, and reviewing; M.K.B.: Collection and collation of data, and final approval of manuscript; S.D.: Collection of data, manuscript drafting, and reviewing.




Publication History

Article published online:
05 June 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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