Management of cerebrospinal fluid leak after surgical removal of pituitary adenomas.
OBJECTIVE
The aim of the study was to evaluate the frequency and the causes of the intra- and postoperative cerebrospinal fluid (CSF) leaks and to discuss the sella closure methods.


METHODS
During the period from 1995 to 2005, 313 patients underwent 356 transsphenoidal operations for pituitary adenoma. Microadenoma was found in 80 (22.5%) cases, and in 276 (77.5%) cases, macroadenoma was removed. Two different methods to close the sella were used. The first one consisted packing the sella turcica and sphenoidal sinus with autologous fat and restoring the defect of sella turcica with autologous bone. In more resent practice, the regenerated oxidized cellulose (Surgicel) and collagen sponge with human fibrin (TachoSil) were used to cover the sella membrane defect, followed by packing the sella with autologous fat and covering the dural defect with Surgicel and TachoSil.


RESULTS
Adenoma was totally removed in 198 (55.6%) cases out of 356. Microadenoma was totally removed in 91.3% and macroadenoma in 45.3% of cases, respectively. Postoperative complications were noted in 40 (11.2%) patients. Two (0.6%) patients died after surgery. Intraoperative CSF leakage was observed in 58 (16.3%) cases. Postoperative CSF leakages were observed in 3 cases, when the method of packing the sella with just autologous fat was used, whereas in 29 cases when the sella fat packing was used together with Surgicel and TachoSil to cover the sella membrane and dural defects, no postoperative CSF leakages were observed.


CONCLUSIONS
The technique of covering the sella membrane and dural defects with Surgicel and TachoSil in the presence of intraoperative CSF leakage appeared to be the most reliable one, as no postoperative CSF leakage applying this technique has been observed.
Tamasauskas
Arimantas
A
Department of Neurosurgery, Kaunas University of Medicine, Eiveniu 2, 50009 Kaunas, Lithuania. a.tamasauskas@kmu.lt
Sinkūnas
Kestutis
K
Draf
Wolfgang
W
Deltuva
Vytenis
V
Matukevicius
Algimantas
A
Rastenyte
Daiva
D
Vaitkus
Saulius
S
D049913:ACTH-Secreting Pituitary Adenoma / Q000601:surgery; D000236:Adenoma / Q000601:surgery*; D000368:Aged; D016025:Bone Transplantation; D002483:Cellulose, Oxidized / Q000627:therapeutic use; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D004338:Drug Combinations; D005260:Female; D005340:Fibrinogen / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control / Q000601:surgery*; D015175:Prolactinoma / Q000601:surgery*; D012658:Sella Turcica / Q000601:surgery*; D013101:Sphenoid Sinus / Q000601:surgery*; D015503:Surgical Sponges; D013917:Thrombin / Q000627:therapeutic use; D013997:Time Factors
D002483:Cellulose, Oxidized; D004338:Drug Combinations; C518955:TachoSil; C013695:Surgicel; D005340:Fibrinogen; D013917:Thrombin