title: Low-grade CSF leaks in endoscopic trans-sphenoidal pituitary surgery: efficacy of a simple and fully synthetic repair with a hydrogel sealant.
abstract: BACKGROUND
  Intra-operative CSF leak during endoscopic trans-sphenoidal surgery is not uncommon. Surgical repair with a variety of autologous grafts, rigid buttresses and CSF diversion techniques that add time and complexity have been reported.
  
  
  OBJECTIVE
  To describe a simple and purely synthetic closure for low-grade CSF leaks following endoscopic trans-sphenoidal pituitary surgery.
  
  
  METHODS
  A retrospective review of all endoscopic trans-sphenoidal surgery undertaken for pituitary pathology between 2005 and 2010 was carried out. The grade of CSF leak and success of graded repair was noted. Patients with no CSF leak (grade 0) had gelatin sponge placed in the tumour cavity. In those with low-grade CSF leak through small arachnoid defects (grade 1), repair was carried out using gelatin sponge and hydrogel sealant overlay. CSF diversion was not employed for low-grade CSF leaks.
  
  
  RESULTS
  Of the 255 endoscopic trans-sphenoidal surgeries, 158 (62%) had no leak (grade 0) and 74 (29%) had a low-grade leak (grade 1). Repairs in all cases were of grade 0, and all but two cases of grade 1 CSF leak were successful at a mean follow-up of 29 months. The 2 (2.7%) post-operative CSF leaks were seen within 6 weeks of surgery. Both cases were related to bouts of sneezing and were repaired using further trans-sphenoidal surgery and/or lumbar CSF diversion.
  
  
  CONCLUSIONS
  A simple purely synthetic repair of low-grade CSF leaks is described. This repair is safe and comparable in efficacy whilst avoiding the morbidity related to more complex sellar reconstructions previously described.
authors.affiliation: Department of Neurosurgery, Greater Manchester Neurosciences Centre, Salford Royal Foundation Trust, Salford, UK. yiyuen.wang@svhm.org.au
authors.forename: Yi Yuen
authors.initials: YY
authors.lastname: Wang
authors.forename: Tara
authors.initials: T
authors.lastname: Kearney
authors.forename: Kanna K
authors.initials: KK
authors.lastname: Gnanalingham
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000273:Adipose Tissue / Q000637:transplantation; D000328:Adult; D000368:Aged; D001099:Arachnoid / Q000601:surgery; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis / Q000601:surgery; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005339:Fibrin Foam; D005500:Follow-Up Studies; D006801:Humans; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate / Q000008:administration & dosage*; D007016:Hypophysectomy / Q000379:methods*; D007431:Intraoperative Complications / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000175:diagnosis; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis; D012189:Retrospective Studies; D013526:Surgical Mesh; D014014:Tissue Adhesives; D016896:Treatment Outcome
chemical_list: D005339:Fibrin Foam; D014014:Tissue Adhesives; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate