Use of equine collagen foil as dura mater substitute in endoscopic endonasal transsphenoidal surgery.
OBJECTIVE
This study describes the use of a novel collagen-based dural substitute in endoscopic endonasal transsphenoidal surgery.


METHODS
Operative records were reviewed for a 12-month period for all patients who underwent surgery by means of an endoscopic endonasal transsphenoidal approach since we began using TissuDura (Baxter, Vienna, Austria) collagen-only dural substitute in January 2004.


RESULTS
During the 12-month period evaluated, we performed an endoscopic endonasal transsphenoidal operation for a variety of pituitary lesions on 72 consecutive patients. Among these, 15 patients (20.8%) required the implant of the collagen foil. Nine patients (60%) presented an intraoperative CSF leak (3 small weeping of CSF and 6 larger leaks); in these cases, the TissuDura was used against the arachnoid membrane, followed by the other materials used for the repair. In 7 other subjects without any evidence of CSF escape, the collagen foil was used to protect and enforce the arachnoidal membrane descent into the sellar cavity to prevent its possible postoperative rupture and consequent CSF leak. Fibrin glue was used in all cases. A postoperative CSF leak with meningitis occurred in only 1 (6.7%) of the 15 subjects. The patient required a reoperation for CSF fistula repair and intravenous antibiotics.


CONCLUSIONS
Even if based on a relatively small patient series, our experience demonstrated that the use of TissuDura in transsphenoidal surgery is safe and biocompatible, as compared with other dural substitutes.
Cappabianca
Paolo
P
Department of Neurological Sciences, Division of Neurosurgery-Università degli Studi di Napoli Federico II, 80131 Naples, Italy. paolo.cappabianca@unina.it
Esposito
Felice
F
Cavallo
Luigi M
LM
Messina
Andrea
A
Solari
Domenico
D
di Somma
Lucia G M
LG
de Divitiis
Enrico
E
D000818:Animals; D001672:Biocompatible Materials; D001927:Brain Diseases / Q000601:surgery*; D003094:Collagen; D004388:Dura Mater / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D006736:Horses; D006801:Humans; D008279:Magnetic Resonance Imaging; D019635:Neurosurgical Procedures / Q000379:methods*; D009666:Nose / Q000601:surgery; D011183:Postoperative Complications; D013100:Sphenoid Bone / Q000601:surgery; D013526:Surgical Mesh; D016896:Treatment Outcome
D001672:Biocompatible Materials; D003094:Collagen