[Reconstruction of the sellar floor in transsphenoidal surgery: our experience of 818 patients].
OBJECTIVE
Transsphenoidal microsurgery (TSS) is the method of choice for resection of most pituitary tumors. Postoperative cerebrospinal fluid rhinorrhea is one of the most frequent complications of TSS. Its incidence ranges from 1.3 to 9.6%. Failure to close a cerebrospinal fistula can result in life-threatening complications e. g. meningitis or tension pneumocephalus. Therefore sellar closure has to be done properly certainly and has to be watertight. The aim of the study was to evaluate the results of reconstruction of the skull base after TSS with autologous material (fascia lata and fat or muscle).


METHODS
Our operative experience of reconstruction of the sellar floor during transsphenoidal surgery is described. We report the well known method of the sellar closure using autologous tissue (fascia lata and fat or muscle). We did not use other materials e.g., fibrin glue, titanium mesh etc. This technique has been performed in 316 patients.


RESULTS
The postoperative cerebrospinal fluid leakage occurred in 7 patients. Four of them underwent early reoperation. Three others were treated successfully with lumbar drainage. In another patient, a cerebrospinal fistula occurred during chronic pharmacotherapy of the giant PRL-secreting adenoma. Transsphenoidal reconstruction of the skull base according to the described method was performed in that case. Lethal meningitis occurred in one patient in our group.


CONCLUSIONS
In our opinion the described method of reconstruction of the sellar floor is easy, safe and very effective.
Zieliński
Grzegorz
G
Klinika Neurochirurgii, Wojskowy Instytut Medyczny, 00-909 Warszawa. gmz@wim.mil.pl
Podgórski
Jan Krzysztof
JK
Koziarski
Andrzej
A
Potakiewicz
Ziemowit
Z
D000328:Adult; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery*; D002557:Cerebrospinal Fluid Shunts / Q000379:methods; D005260:Female; D006801:Humans; D007016:Hypophysectomy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000601:surgery*; D011044:Poland; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012658:Sella Turcica / Q000473:pathology / Q000601:surgery*