Reconstruction of the sellar dura in transsphenoidal surgery using an expanded polytetrafluoroethylene dural substitute.
BACKGROUND
The transsphenoidal approach for resecting pituitary tumors has classically included reconstruction of the anterior wall of the sella turcica. A variety of materials have been used in this process for the purpose of both recreating the original anatomy and preventing postoperative cerebrospinal fluid (CSF) leaks. We studied the use of an ePTFE dural substitute (GORE Preclude MVP, W.L. Gore & Associates, Flagstaff, Arizona, USA), as a method for obtaining reliable reconstruction of the sellar dura.


METHODS
A prospective alternate case trial was designed to assess this new dural substitute wherein 60 patients who underwent transsphenoidal surgical resection of intrasellar lesions larger than 1 cm were included. Thirty patients had the sellar dura closed with ePTFE dural substitute, whereas 30 patients underwent anterior wall reconstruction as ordinarily performed in our institution.


RESULTS
Each patient was reassessed at closure, and the operative site and sphenoid sinus were evaluated with 3-months-postoperative magnetic resonance imaging. Three patients experienced postoperative CSF leaks: 1 with ePTFE dural substitute and 2 without. All 3 patients underwent a second operation to repair the CSF leak, without further complications. No other postoperative complications were noted in the series.


CONCLUSIONS
Expanded polytetrafluoroethylene dural substitute provides a safe and effective adjunctive method for reconstruction of the sellar dura.
Sherman
Jonathan H
JH
Department of Neurological Surgery, University of Virginia, Health Sciences Center, Charlottesville, Box 800212, VA 22908, USA. js2bx@virginia.edu
Pouratian
Nader
N
Okonkwo
David O
DO
Jane
John A
JA
Laws
Edward R
ER
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018786:Bone Substitutes / Q000627:therapeutic use*; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery*; D011138:Polytetrafluoroethylene / Q000627:therapeutic use*; D011446:Prospective Studies; D012658:Sella Turcica / Q000601:surgery*; D016896:Treatment Outcome
D018786:Bone Substitutes; D011138:Polytetrafluoroethylene