Pituitary tumors: our experience in the prevention of postoperative cerebrospinal fluid leaks after transsphenoidal surgery.
The objective was to analyze the management of intraoperative CSF leaks in transsphenoidal surgeries to prevent postoperative cerebrospinal fluid (CSF) leaks. Sixty-three pituitary tumors were operated by transnasal approach. In presence of arachnoidal opening, a fat graft was placed into the sellar cavity, followed by collagen sponge layer and fibrin glue. The sphenoid sinus was also packed with fat graft and collagen sponge. An external CSF lumbar drainage was kept for 2-4 days. The variables analyzed were: intraoperative and postoperative CSF leaks, procedures, and related complications. The overall incidence of postoperative CSF leak was 1.5%. Twenty patients (31.7%) had intraoperative arachnoidal opening, 5% of whom had postoperative CSF leak. There were no reoperations because of CSF leak, and no secondary intrasellar arachnoidoceles. Mean follow-up was 3.6 years. The preventive treatment had good results and there were no complications related to the intervention strategy, encouraging us to continue performing this simple, effective, and inexpensive procedure.
Instituto de Investigaciones Médicas A Lanari, Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina. alejandrarabadan@speedy.com.ar
Alejandra T
AT
Rabadán
Diego
D
Hernández
C Santiago
CS
Ruggeri
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002559:Cerebrospinal Fluid Rhinorrhea / Q000453:epidemiology / Q000517:prevention & control* / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods*; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control* / Q000601:surgery; D055815:Young Adult