Abstract
Background: The adequate repair of intraoperative CSF leaks during transsphenoidal surgery remains a challenge. The authors describe the application of n-butyl 2-cyanoacrylate (cyanoacrylate) tissue glue for repair of CSF fistulas during transsphenoidal surgery.
Methods: The authors retrospectively reviewed the records of 221 consecutive patients who underwent transsphenoidal surgery during 1998–2007. Among these patients, 52 (24%) experienced detectable intraoperative CSF leakage. The CSF fistulas were graded on a scale of 1–3, according to the amount of CSF loss and extent of diaphragmatic disruption. 39 patients who had an average leak scale of 1.28 received cyanoacrylate glue to seal the floor. The remaining 13 patients who were not part of this report received other dura sealant substitutes, including Tisseel and Dura Seal, or fat/cartilage grafts without any additional glue material.
Results: 4 of 221 patients (2%) who underwent surgery had postoperative CSF fistula. Of the 39 patients who underwent repair of their fistula using fat graft, cartilage/bone buttress and cyanoacrylate reconstruction, 2 (5.13%) developed postoperative CSF fistulas without any other side effects. The average intraoperative leak grade in these 2 patients was 2.00.
Conclusions: The authors used cyanoacrylate glue for intraoperative repair of higher grade CSF fistulas. As an adjunct to careful sellar reconstruction, cyanoacrylate glue appears to be effective and safe in preventing postoperative CSF leakage after transsphenoidal surgery.
Key words
transsphenoidal surgery - CSF leak - cyanoacrylate - pituitary adenoma
References
-
1
Dusick JR, Esposito F, Mattozo CA. et al .
Endonasal transsphenoidal surgery: the patient's perspective-survey results from 259 patients.
Surg Neurol.
2006;
65
332-341
discussion 332–341
-
2
Jane Jr JA, Laws Jr ER.
The surgical management of pituitary adenomas in a series of 3 093 patients.
J Am Coll Surg.
2001;
193
651-659
-
3
Mortini P, Losa M, Barzaghi R. et al .
Results of transsphenoidal surgery in a large series of patients with pituitary adenoma.
Neurosurgery.
2005;
56
1222-1233
discussion 1233
-
4
Couldwell WT, Weiss MH, Rabb C. et al .
Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases.
Neurosurgery.
2004;
55
539-547
discussion 547–550
-
5
Jane Jr JA, Thapar K, Kaptain GJ. et al .
Pituitary surgery: transsphenoidal approach.
Neurosurgery.
2002;
51
435-442
discussion 434–442
-
6
Black PM, Zervas NT, Candia GL.
Incidence and management of complications of transsphenoidal operation for pituitary adenomas.
Neurosurgery.
1987;
20
920-924
-
7
Ciric I, Ragin A, Baumgartner C. et al .
Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience.
Neurosurgery.
1997;
40
225-236
discussion 227–236
-
8
Cappabianca P, Cavallo LM, Mariniello G. et al .
Easy sellar reconstruction in endoscopic endonasal transsphenoidal surgery with polyester-silicone dural substitute and fibrin glue: technical note.
Neurosurgery.
2001;
49
473-475
discussion 475–476
-
9
Cappabianca P, Cavallo LM, Valente V. et al .
Sellar repair with fibrin sealant and collagen fleece after endoscopic endonasal transsphenoidal surgery.
Surg Neurol.
2004;
62
227-233
discussion 233
-
10
Maxwell J, Goldware S.
Use of tissue adhesive in the surgical treatment of cerebrospinal fluid leaks.
J Neurosurg.
1973;
39
332-336
-
11
Tse DT, Panje WR, Anderson RL.
Cyanoacrylate adhesive used to stop CSF leaks during orbital surgery.
Arch Ophthalmol.
1984;
102
1337-1339
-
12
Vander Ark G, Pitkethly D, Ducker T.
Repair of cerebrospinal fistulas using a tissue adhesive.
J Neurosurg.
1970;
33
151-155
-
13
Wang MY, Levy ML, Mittler MA. et al .
A prospective analysis of the use of octylcyanoacrylate tissue adhesive for wound closure in pediatric neurosurgery.
Pediatr Neurosurg.
1999;
30
186-188
-
14
Young W, Gates G.
The use of cyanoacrylate in transsphenoidal hypophysectomy.
The Laryngoscope.
1978;
88
1784-1788
-
15
Seda L, Camara RB, Cukiert A. et al .
Sellar floor reconstruction after transsphenoidal surgery using fibrin glue without grafting or implants: technical note.
Surg Neurol.
2006;
66
46-49
discussion 49
-
16
Zada G, Kelly DF, Cohan P. et al .
Endonasal transsphenoidal approach for pituitary adenomas and other sellar lesions: an assessment of efficacy, safety, and patient impressions.
J Neurosurg.
2003;
98
350-358
-
17 Esposito F, Kelly DF. Closure Methods.. Philadelphia: Elsevier, Inc; 2006
-
18
Eiferman RA, Snyder JW.
Antibacterial effect of cyanoacrylate glue.
Arch Ophthalmol.
1983;
101
958-960
-
19
Lehman R, West R, Leonard F.
Toxicity of alkyl 2-cynaoacrylates. II. Bacterial growth.
Arch Surg.
1966;
93
447-450
-
20
Lehman R, Hayes GJ.
The toxicity of alkyl 2-cyanoacrylate tissue and adhesive: brain and blood vessels.
Surgery, St Louise.
1967;
61
915-922
-
21
Ozisik PA, Inci S, Soylemezoglu F. et al .
Comparative dural closure techniques: a safety study in rats.
Surg Neurol.
2006;
65
42-47
discussion 47
-
22
Feinberg EB, Funderburk R.
Infectious disease risks of fibrin glue.
Ophthalmic Surg.
1993;
24
206
-
23
Kitoh A, Arima Y, Nishigori C. et al .
Tissue adhesive and postoperative allergic meningitis.
Lancet.
2002;
359
1668-1670
-
24
de Vries J, Menovsky T, van Gulik S. et al .
Histological effects of fibrin glue on nervous tissue: a safety study in rats.
Surg Neurol.
2002;
57
415-422
discussion 422
Correspondence
A. A. Cohen-GadolMD, MSc
Goodman-Campbell Brain &
Spine and Indiana University
Department of Neurosurgery
1801 North Senate Blvd # 610
Indianapolis
IN 46202
USA
Phone: +1/317/396 1258
Fax: +1/317/924 8472
Email: acohenmd@gmail.com
