Sellar Reconstruction and Rates of Delayed Cerebrospinal Fluid Leak after Endoscopic Pituitary Surgery

Chris Sanders-Taylor; Amjad Anaizi; Jennifer Kosty; Lee A. Zimmer; Phillip V. Theodosopoulos

doi:10.1055/s-0034-1544118

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2015; 76(04): 281-285
DOI: 10.1055/s-0034-1544118

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Sellar Reconstruction and Rates of Delayed Cerebrospinal Fluid Leak after Endoscopic Pituitary Surgery

Chris Sanders-Taylor

¹Department of Neurosurgery, University of Cincinnati College of Medicine; Brain Tumor Center at UC Neuroscience Institute, Mayfield Clinic, Cincinnati, Ohio, United States

,

Amjad Anaizi

¹Department of Neurosurgery, University of Cincinnati College of Medicine; Brain Tumor Center at UC Neuroscience Institute, Mayfield Clinic, Cincinnati, Ohio, United States

,

Jennifer Kosty

¹Department of Neurosurgery, University of Cincinnati College of Medicine; Brain Tumor Center at UC Neuroscience Institute, Mayfield Clinic, Cincinnati, Ohio, United States

,

Lee A. Zimmer

²Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine; Brain Tumor Center at UC Neuroscience Institute, Mayfield Clinic, Cincinnati, Ohio, United States

,

Phillip V. Theodosopoulos

³Department of Neurological Surgery, University of California San Francisco, San Francisco, California, United States

› Author Affiliations

Abstract

Objectives Delayed cerebrospinal fluid (CSF) leaks are a complication in transsphenoidal surgery, potentially causing morbidity and longer hospital stays. Sella reconstruction can limit this complication, but is it necessary in all patients?

Design Retrospective review.

Setting Single-surgeon team (2005–2012) addresses this trend toward graded reconstruction.

Participants A total of 264 consecutive patients with pituitary adenomas underwent endoscopic transsphenoidal resections. Sellar defects sizable to accommodate a fat graft were reconstructed.

Main outcomes Delayed CSF leak and autograft harvesting.

Results Overall, 235 (89%) had reconstruction with autograft (abdominal fat, septal bone/cartilage) and biological glue. Delayed CSF leak was 1.9%: 1.7%, and 3.4% for reconstructed and nonreconstructed sellar defects, respectively (p = 0.44). Complications included one reoperation for leak, two developed meningitis, and autograft harvesting resulted in abdominal hematoma in 0.9% and wound infection in 0.4%.

Conclusion In our patients, delayed CSF leaks likely resulted from missed intraoperative CSF leaks or postoperative changes. Universal sellar reconstruction can preemptively treat missed leaks and provide a barrier for postoperative changes. When delayed CSF leaks occurred, sellar reconstruction often allowed for conservative treatment (i.e., lumbar drain) without repeat surgery. We found universal reconstruction provides a low risk of delayed CSF leak with minimal complications.

Keywords

pituitary tumor - sella - cerebrospinal fluid rhinorrhea - neuroendoscopy - complications

Full Text

References

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