Dural suturing for repair of cerebrospinal fluid leak in transnasal transsphenoidal surgery.
OBJECTIVE
Repair of a cerebrospinal fluid (CSF) leak after transsphenoidal surgery (TSS) is usually accomplished using various graft materials. These methods are effective in most, but not all, cases.


METHODS
Since 2006, we have been directly suturing the sellar floor dura in patients with an intraoperative CSF leak. Fat and/or fascial grafts were utilized only when a major CSF leak developed. The incidence of postoperative CSF rhinorrhea was compared before and after the suture.


RESULTS
Postoperative CSF rhinorrhea developed in 3.7% (7 out of 188) of cases before 2005, but never since the dural suture was introduced (0 out of 136, 0%; P = 0.0229). Although watertight closure was not achieved in some cases, narrowing the dural defect and supporting the intrasellar graft was attained in every case. Surgical time was approximately 30 min longer in patients who underwent dural suture (148 +/- 42 min) than those who did not (119 +/- 37 min; P = 0.0001).


CONCLUSIONS
Direct suturing of the sellar dura is a simple, safe, and reliable surgical technique for repairing CSF leaks after TSS. Using this procedure, more than 70% of patients with an intraoperative CSF leak can avoid autologous tissue grafts.
Nishioka
Hiroshi
H
Department of Neurosurgery, Hachioji Medical Center, Tokyo Medical University, Hachioji, Tokyo 193-0998, Japan. nishioka@tokyo-med.ac.jp
Izawa
Hitoshi
H
Ikeda
Yukio
Y
Namatame
Hiroaki
H
Fukami
Shinjiro
S
Haraoka
Jo
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D004388:Dura Mater / Q000033:anatomy & histology / Q000293:injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000033:anatomy & histology / Q000293:injuries / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012658:Sella Turcica / Q000033:anatomy & histology / Q000293:injuries / Q000601:surgery; D013100:Sphenoid Bone / Q000033:anatomy & histology / Q000293:injuries / Q000601:surgery*; D013536:Suture Techniques; D016378:Tissue Transplantation / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult