title: Prevention of cerebrospinal fluid rhinorrhea after transsphenoidal surgery by collagen fleece coated with fibrin sealant without autologous tissue graft or postoperative lumbar drainage.
abstract: BACKGROUND
  Autologous tissue grafting and postoperative lumbar cerebrospinal fluid (CSF) drainage (PLD) have been used to prevent CSF rhinorrhea after transsphenoidal surgery.
  
  
  OBJECTIVE
  To describe the technical details and efficacy of our techniques of using collagen fleece coated with fibrin sealant (TachoComb, Nycomed, Linz, Austria) instead of an autologous tissue graft and refraining from the use of PLD.
  
  
  METHODS
  We retrospectively reviewed 307 consecutive patients who underwent a transsphenoidal surgery for pituitary adenoma from November 2005 to February 2008. Among them, 90 cases of intraoperative CSF leaks were repaired with TachoComb without an autologous tissue graft or PLD. The repair procedures were tailored according to CSF leakage type, and we used only Bioglue (Cryolife Inc, Atlanta, Georgia) for sellar floor reconstruction.
  
  
  RESULTS
  The overall rate of CSF rhinorrhea was 2.2% (2 of 90 cases). The 2 cases of CSF rhinorrhea resulted from large arachnoid defects, and there were no adverse effects from TachoComb such as transmission of viral disease or infection.
  
  
  CONCLUSIONS
  Our technique is an alternative method to the traditional autologous tissue graft technique. PLD is not an essential procedure for the prevention of CSF rhinorrhea if the intraoperative CSF leak is completely sealed off during the transsphenoidal surgery. However, in cases of large arachnoid defects, aggressive repair of the arachnoid defect and sellar floor reconstruction with bone or bony substitutes should be considered in conjunction with our methods.
authors.affiliation: Department of Neurosurgery, Pituitary Tumor Clinic, Yonsei Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jin Mo
authors.initials: JM
authors.lastname: Cho
authors.forename: Jung Yong
authors.initials: JY
authors.lastname: Ahn
authors.forename: Jong Hee
authors.initials: JH
authors.lastname: Chang
authors.forename: Sun Ho
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000517:prevention & control*; D003094:Collagen; D005260:Female; D015718:Fibrin Tissue Adhesive; D006801:Humans; D007016:Hypophysectomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery; D010911:Pituitary Neoplasms / Q000601:surgery; D011183:Postoperative Complications / Q000503:physiopathology*; D012189:Retrospective Studies; D013100:Sphenoid Bone / Q000033:anatomy & histology / Q000601:surgery*; D014014:Tissue Adhesives / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives; D003094:Collagen