title: Use of equine pericardium sheet (LYOMESH®) as dura mater substitute in endoscopic endonasal transsphenoidal surgery.
abstract: OBJECTIVE
  The aim of this study was to describe the use of equine pericardium sheet (Lyomesh (®) ) as dural substitute for sellar reconstruction after endoscopic endonasal transsphenoidal surgery for the removal of pituitary adenomas.
  
  
  METHODS
  We reviewed data of patients that underwent surgery by means of an endoscopic endonasal transsphenoidal approach for the removal of pituitary adenomas over a 12-months period, starting in May 2012, i.e. when we adopted Lyomesh (®) (Audio Technologies, Piacenza, Italy) an equine pericardium sheet, as dura mater substitute.
  
  
  RESULTS
  During the 12-months period evaluated, we performed an endoscopic endonasal transsphenoidal operation for a variety of pituitary lesions on 102 consecutive patients. Among these, in 12 patients (9.4%) harboring a pituitary adenoma, the implant of the pericardium sheet was used. Four patients (33.3%) presented a small intraoperative cerebrospinal fluid (CSF) leak; in these cases the Lyomesh (®) was placed intradurally with fibrin glue and, thereafter, several layers were positioned in extradural space. In 8 other subjects without any evidence of CSF leak, the dural substitute was placed intradurally and fibrin glue was injected intradurally to hold the material in place.
  
  
  CONCLUSIONS
  Even if based on a relatively small patient series, our experience demonstrated that the use of equine pericardium sheet (Lyomesh (®) ) as dura mater substitute in transsphenoidal surgery is safe and biocompatible, as compared with other dural substitutes.
authors.affiliation: Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II Naples, Italy.
authors.forename: Luigi M
authors.initials: LM
authors.lastname: Cavallo
authors.forename: Domenico
authors.initials: D
authors.lastname: Solari
authors.forename: Teresa
authors.initials: T
authors.lastname: Somma
authors.forename: Alberto
authors.initials: A
authors.lastname: Di Somma
authors.forename: Carmela
authors.initials: C
authors.lastname: Chiaramonte
authors.forename: Paolo
authors.initials: P
authors.lastname: Cappabianca
keywords: CSF leak; Dural Substitutes; Endoscopic Endonasal Surgery; Skull Base Reconstruction