title: Sellar Reconstruction and Rates of Delayed Cerebrospinal Fluid Leak after Endoscopic Pituitary Surgery.
abstract: Objectives Delayed cerebrospinal fluid (CSF) leaks are a complication in transsphenoidal surgery, potentially causing morbidity and longer hospital stays. Sella reconstruction can limit this complication, but is it necessary in all patients? Design Retrospective review. Setting Single-surgeon team (2005-2012) addresses this trend toward graded reconstruction. Participants A total of 264 consecutive patients with pituitary adenomas underwent endoscopic transsphenoidal resections. Sellar defects sizable to accommodate a fat graft were reconstructed. Main outcomes Delayed CSF leak and autograft harvesting. Results Overall, 235 (89%) had reconstruction with autograft (abdominal fat, septal bone/cartilage) and biological glue. Delayed CSF leak was 1.9%: 1.7%, and 3.4% for reconstructed and nonreconstructed sellar defects, respectively (p = 0.44). Complications included one reoperation for leak, two developed meningitis, and autograft harvesting resulted in abdominal hematoma in 0.9% and wound infection in 0.4%. Conclusion In our patients, delayed CSF leaks likely resulted from missed intraoperative CSF leaks or postoperative changes. Universal sellar reconstruction can preemptively treat missed leaks and provide a barrier for postoperative changes. When delayed CSF leaks occurred, sellar reconstruction often allowed for conservative treatment (i.e., lumbar drain) without repeat surgery. We found universal reconstruction provides a low risk of delayed CSF leak with minimal complications.
authors.affiliation: Department of Neurosurgery, University of Cincinnati College of Medicine; Brain Tumor Center at UC Neuroscience Institute, Mayfield Clinic, Cincinnati, Ohio, United States.
authors.forename: Chris
authors.initials: C
authors.lastname: Sanders-Taylor
authors.affiliation: Department of Neurosurgery, University of Cincinnati College of Medicine; Brain Tumor Center at UC Neuroscience Institute, Mayfield Clinic, Cincinnati, Ohio, United States.
authors.forename: Amjad
authors.initials: A
authors.lastname: Anaizi
authors.affiliation: Department of Neurosurgery, University of Cincinnati College of Medicine; Brain Tumor Center at UC Neuroscience Institute, Mayfield Clinic, Cincinnati, Ohio, United States.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kosty
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine; Brain Tumor Center at UC Neuroscience Institute, Mayfield Clinic, Cincinnati, Ohio, United States.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Zimmer
authors.affiliation: Department of Neurological Surgery, University of California San Francisco, San Francisco, California, United States.
authors.forename: Phillip V
authors.initials: PV
authors.lastname: Theodosopoulos
keywords: cerebrospinal fluid rhinorrhea; complications; neuroendoscopy; pituitary tumor; sella