title: Management of intra-operative cerebrospinal fluid leak following endoscopic trans-sphenoidal pituitary surgery.
abstract: OBJECTIVE
  Cerebrospinal fluid leakage is the most common complication of endoscopic trans-sphenoidal pituitary surgery. However, there is no uniformly accepted way of managing this complication when it occurs intra-operatively. This paper describes a quick, simple technique, involving layered fibrin glue and gelatin sponge, which does not compromise post-operative patient follow up.
  
  
  METHODS
  Retrospective review of all endoscopic pituitary surgery cases conducted at a single institution since the introduction of this technique in 2002.
  
  
  RESULTS
  A total of 120 endoscopic pituitary operations were performed (96 primary procedures and 24 revisions). All intra-operative cerebrospinal fluid leaks were managed using the described method, with a failure rate of 3.6 per cent. The overall post-operative leakage rate was 1.7 per cent.
  
  
  CONCLUSIONS
  This simple, conservative technique avoids the need for further dissection and the use of non-absorbable foreign material, and has a low incidence of post-operative cerebrospinal fluid leakage.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Western Health, Melbourne, Victoria, Australia. chris.hobbs@doctors.org.uk
authors.forename: C G L
authors.initials: CG
authors.lastname: Hobbs
authors.forename: A
authors.initials: A
authors.lastname: Darr
authors.forename: W V
authors.initials: WV
authors.lastname: Carlin
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000368:Aged; D001729:Bismuth / Q000627:therapeutic use; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000628:therapy; D004338:Drug Combinations; D004724:Endoscopy; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D006847:Hydrocarbons, Iodinated / Q000627:therapeutic use; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D010911:Pituitary Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D013101:Sphenoid Sinus / Q000601:surgery
chemical_list: D004338:Drug Combinations; D015718:Fibrin Tissue Adhesive; D006490:Hemostatics; D006847:Hydrocarbons, Iodinated; C045757:bismuth iodoform paraffin paste; D001729:Bismuth