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J Neurol Surg B Skull Base 2013; 74(03): 155-159
DOI: 10.1055/s-0033-1338263
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Acellular Dermal Allograft for Sellar Repair after Transsphenoidal Approach to Pituitary Adenomas

Brandon G. Gaynor
1   Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
,
Ronald J. Benveniste
1   Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
,
Seth Lieberman
2   Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
,
Roy Casiano
2   Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
,
Jacques J. Morcos
1   Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
› Author Affiliations
Further Information

Publication History

04 November 2012

07 January 2013

Publication Date:
13 March 2013 (online)

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Abstract

Objectives Our practice has transitioned from using fat autograft to acellular dermal matrix (AlloDerm, LifeCell Corp, Woodlands, Texas, USA). We present the largest series to our knowledge of AlloDerm for sellar floor repair after transsphenoidal approach to pituitary adenoma and compare rates of postoperative cerebrospinal fluid (CSF) leak with an earlier cohort of patients whose CSF leaks were repaired with fat autograft.

Design This is a retrospective cohort study comparing sellar repair with fat autograft versus inlay Alloderm between the years 2003 and 2012. The primary end point was postoperative CSF leak.

Results A total of 429 patients (368 primary; 83 revision operations) without intraoperative lumbar drainage were included. A total of 18 postoperative CSF leaks were observed (3.9%). Intraoperative CSF leak occurred in 160 cases (35.5%). Among this subset of patients with intraoperative CSF leak, 95 underwent repair with AlloDerm and 46 underwent repair with fat autograft, with postoperative CSF leak rates of 8.4% and 15.2%, respectively (p = 0.34, chi-square test); 19 patients underwent repair with other techniques or no repair at all, with postoperative leak rate of 0%.

Conclusions AlloDerm is an effective alternative to fat autograft in cases of low-flow CSF leak following transsphenoidal resection of pituitary adenoma.

Keywords

pituitary adenoma - acellular dermal matrix - AlloDerm - fat autograft - cerebrospinal fluid leak - transsphenoidal surgery
 

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