title: Sellar reconstruction without intrasellar packing after endoscopic surgery of pituitary macroadenomas is better than its reputation.
abstract: OBJECTIVE
  Sellar reconstruction with intrasellar packing following endoscopic resection of pituitary macroadenomas remains a subject of clinical and radiological discussion particularly, when an intraoperative cerebrospinal fluid (CSF) leakage is absent. This study was conducted to contribute our experience with sellar reconstruction after a standard endoscopic surgery of pituitary macroadenomas without intraoperative CSF leakage to the ongoing discussion between techniques with and without intrasellar packing.
  
  
  METHODS
  A consecutive series of 47 pituitary macroadenomas undergoing excision via a standard endoscopic endonasal transsphenoidal surgery (EETS) without evident intraoperative CSF leakage were retrospectively evaluated over a 10-months mean follow-up period. According to the sellar reconstruction technique, three groups could be identified: Group A - with no intrasellar packing, Group B - with haemostatic materials packing, and Group C - with abdominal fat packing. Postoperative clinical and radiological assessments of the three groups were documented and analyzed for differences in outcome.
  
  
  RESULTS
  Postoperative clinical assessment did not differ significantly between the three groups. In group A, postoperative CSF leakage, sphenoid sinusitis and empty sella syndrome were not observed. However, a significant difference in radiological assessment could be identified; the interpretation of sellar contents in postoperative MRI of group A succeeded earlier and more reliably than in other groups with intrasellar packing.
  
  
  CONCLUSIONS
  There is no difference in the incidence of postoperative CSF leakage and empty sella syndrome among the various reconstructive techniques with and without intrasellar packing, irrespective of size and extension of the pituitary adenoma. Sellar reconstruction without intrasellar packing following a standard EETS is not inferior to other techniques with packing and even shows more radiological advantages, which made it our preferred technique, at least if no intraoperative CSF leakage is evident.
authors.affiliation: Department of Otorhinolaryngology, University Hospital Brussels, Vrije Universiteit Brussels, Brussels, Belgium; Department of Otorhinolaryngology, Minia University Hospital, Minia University, Minya, Egypt.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Ismail
authors.affiliation: Department of Radiology, University Hospital Brussels, Vrije Universiteit Brussels, Brussels, Belgium.
authors.forename: Abd Alla
authors.initials: AA
authors.lastname: Fares
authors.affiliation: Department of Otorhinolaryngology, Minia University Hospital, Minia University, Minya, Egypt.
authors.forename: Balegh
authors.initials: B
authors.lastname: Abdelhak
authors.affiliation: Department of Neurosurgery, University Hospital Brussels, Vrije Universiteit Brussels, Brussels, Belgium.
authors.forename: Jean
authors.initials: J
authors.lastname: D'Haens
authors.affiliation: Department of Otorhinolaryngology, University Hospital Brussels, Vrije Universiteit Brussels, Brussels, Belgium.
authors.forename: Olaf
authors.initials: O
authors.lastname: Michel
mesh_terms: D050153:Abdominal Fat / Q000637:transplantation; D000236:Adenoma / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065634:Cerebrospinal Fluid Leak / Q000209:etiology; D004652:Empty Sella Syndrome / Q000000981:diagnostic imaging / Q000209:etiology; D004724:Endoscopy; D005260:Female; D016558:Hemostasis, Endoscopic / Q000379:methods; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012658:Sella Turcica / Q000000981:diagnostic imaging / Q000601:surgery*; D015524:Sphenoid Sinusitis / Q000209:etiology; D055815:Young Adult
keywords: CSF leakage; intrasellar packing; pituitary macroadenomas; sellar reconstruction; transsphenoidal surgery