Sellar repair with resorbable polyglactin acid sheet and fibrin glue in endoscopic endonasal transsphenoidal surgery.
BACKGROUND
Cerebrospinal fluid leakage after transsphenoidal surgery represents a serious problem. Various methods to prevent postoperative CSF leakage are available, but immediate and tight dural closure is still difficult. The efficacy of a novel sellar repair was described.


METHODS
The sellar repair using absorbable PGA sheet and fibrin glue was applied to 18 consecutive patients with sellar tumors that include 13 pituitary adenomas, 2 craniopharyngiomas, 2 Rathke's cleft cysts, and 1 meningioma within 135 patients who were treated with endoscopic endonasal transsphenoidal approach. The reaction speed and strength between PGA sheets and fibrin glue were examined in vitro.


RESULTS
Polyglactin acid sheets were adhered to the rabbit skin with fibrin glue within 3 minutes and withstood a pressure of more than 220 mm Hg. Postoperative CSF leakage of the patients was not observed in any patients, and excellent adhesion of the PGA sheets to surrounding mucosa was estimated by endoscopic observation after the surgery.


CONCLUSIONS
Repair of the sellar floor with PGA sheet and fibrin glue is a safe and effective method to prevent postoperative CSF leakage, which decreases the necessity for lumbar drainage after the operation.
Yano
Shigetoshi
S
Department of Neurosurgery, Kumamoto University Graduate School, Kumamoto 860-8556, Japan. yanos@kaiju.medic.kumamoto-u.ac.jp
Tsuiki
Hiromasa
H
Kudo
Mareina
M
Kai
Yutaka
Y
Morioka
Motohiro
M
Takeshima
Hideo
H
Yumoto
Eiji
E
Kuratsu
Jun-ichi
J
D020341:Absorbable Implants; D000236:Adenoma / Q000601:surgery; D000328:Adult; D000368:Aged; D003397:Craniopharyngioma / Q000601:surgery; D004724:Endoscopy; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008579:Meningioma / Q000601:surgery; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000601:surgery*; D011098:Polyglactin 910 / Q000627:therapeutic use*; D012658:Sella Turcica / Q000473:pathology / Q000601:surgery*; D013101:Sphenoid Sinus / Q000601:surgery; D014014:Tissue Adhesives / Q000627:therapeutic use*
D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives; D011098:Polyglactin 910