title: Sealing of cerebrospinal fluid leakage during conventional transsphenoidal surgery using a fibrin-coated collagen fleece.
abstract: The prevention of cerebrospinal fluid (CSF) leakage is a key feature of the transsphenoidal approach (TSA) to the pituitary fossa. Although fibrin-coated collagen fleece (Tachosil, Nycomed, Linz, Austria) is a powerful topical hemostatic agent whose usage is increasing in open neurosurgery, the use of Tachosil in TSA surgery has not yet gained wide clinical acceptance. We retrospectively evaluated whether the lone use of Tachosil without additional packing material or postoperative lumbar drainage was effective to prevent CSF leakage in TSA surgery in 101 patients. Additionally, we compared it to a conventional sellar closure technique in 54 patients. Only two (1.9%) of the patients in the Tachosil application group developed postoperative CSF rhinorrhea. No other postoperative complications occurred, including infection or material detachment. However, in the conventional packing group, five (9.3%) patients developed postoperative CSF rhinorrhea and one (1.9%) developed meningitis during the postoperative period. The mean length of postoperative hospital stay was significantly shorter in the Tachosil treatment group than in the standard closure group. These results may indicate that sellar repair using Tachosil can be effective to prevent CSF leakage after TSA surgery, and obviate the need for an autologous tissue graft or postoperative lumbar drainage.
authors: Department of Neurosurgery, Brain Tumor Clinic, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Republic of Korea.
authors: Chang Ki
authors: CK
authors: Hong
authors: Department of Neurosurgery, Brain Tumor Clinic, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Republic of Korea. Electronic address: ybkim69@yuhs.ac.
authors: Yong Bae
authors: YB
authors: Kim
authors: Department of Neurosurgery, Brain Tumor Clinic, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Republic of Korea.
authors: Je Beom
authors: JB
authors: Hong
authors: Department of Neurosurgery, Brain Tumor Clinic, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Republic of Korea.
authors: Kyu Sung
authors: KS
authors: Lee
mesh_terms: D000328:Adult; D065634:Cerebrospinal Fluid Leak / Q000628:therapy*; D002559:Cerebrospinal Fluid Rhinorrhea / Q000517:prevention & control; D002817:Chordoma / Q000601:surgery; D003094:Collagen / Q000627:therapeutic use*; D003388:Cranial Fossa, Posterior / Q000601:surgery; D004338:Drug Combinations; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D005340:Fibrinogen / Q000627:therapeutic use*; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D008581:Meningitis / Q000209:etiology; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D012658:Sella Turcica / Q000601:surgery; D013100:Sphenoid Bone / Q000601:surgery*; D013917:Thrombin / Q000627:therapeutic use*; D014014:Tissue Adhesives / Q000627:therapeutic use*
chemical_list: D004338:Drug Combinations; D015718:Fibrin Tissue Adhesive; C518955:TachoSil; D014014:Tissue Adhesives; D005340:Fibrinogen; D003094:Collagen; D013917:Thrombin
keywords: Cerebrospinal fluid leakage; Complications; Fibrin-coated collagen fleece; Lumbar drainage; Transsphenoidal approach