title: Direct suture technique of normal gland edge on the incised dura margin to repair the intraoperative cerebrospinal fluid leakage from the arachnoid recess during transsphenoidal pituitary tumor surgery.
abstract: BACKGROUND
  During transsphenoidal surgery for pituitary adenomas with large suprasellar extension, cerebrospinal fluid (CSF) leakage commonly develops from a defect at the arachnoid recess between the resected dura margin and the anterior edge of a normal pituitary gland (type 1 CSF leakage).
  
  
  OBJECTIVE
  To evaluate the usefulness of a direct suture technique of the normal gland edge on the incised dural margin to repair intraoperative CSF leakage from the arachnoid recess.
  
  
  METHODS
  Between November 2005 and December 2012, 861 patients with pituitary adenomas were operated on with transsphenoidal surgery, and intraoperative CSF leakage was encountered in 432 patients. Type 1 CSF leakage developed in a total of 122 patients, and their defects were repaired with the direct suture technique in 51 patients, whereas a fleece-coated fibrin glue patch alone was applied onto the defect in the other 71 patients. This direct suture technique required an additional 5 to 20 minutes in most cases.
  
  
  RESULTS
  We experienced no case of postoperative CSF rhinorrhea in the 51 patients whose defects were repaired by the direct suture technique and only 1 case of CSF rhinorrhea in 71 patients whose defects were repaired with a fleece-coated fibrin glue patch alone. There was no statistical difference in the outcome between 2 groups. Postoperative lumbar CSF drainage was not performed in any case.
  
  
  CONCLUSIONS
  Our 2 different repair techniques for arachnoid recess tears are very reliable methods for managing this type of CSF leakage. The direct suture technique may be more appropriate for type 1 CSF leakage with a wider gap and more prominent CSF leakage.
authors.affiliation: *Department of Neurosurgery, ‡Pituitary Tumor Clinic, and §Yonsei Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Eui Hyun
authors.initials: EH
authors.lastname: Kim
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Roh
authors.forename: Hun Ho
authors.initials: HH
authors.lastname: Park
authors.forename: Ju Hyung
authors.initials: JH
authors.lastname: Moon
authors.forename: Je Beom
authors.initials: JB
authors.lastname: Hong
authors.forename: Sun Ho
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001099:Arachnoid / Q000601:surgery; D065634:Cerebrospinal Fluid Leak / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D004388:Dura Mater / Q000601:surgery*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000601:surgery*; D013536:Suture Techniques; D013537:Sutures; D014014:Tissue Adhesives / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives