Sellar repair with autologous muscle and composite septal cartilage grafts for treatment of cerebrospinal fluid leakage following trans-sphenoidal pituitary surgery.
BACKGROUND
Many reconstructive techniques have been proposed to prevent postoperative cerebrospinal fluid (CSF) leakage after trans-sphenoidal pituitary surgery. However, no total agreement has been reached to the best technique.


OBJECTIVE
Assessment of the efficacy of sellar repair with autologous muscle and composite septal cartilage grafts for treatment of intraoperative and delayed postoperative CSF leakage following trans-sphenoidal pituitary surgery without the use of postoperative external lumbar CSF drain.


METHODS
This is a retrospective case series study, level IV evidence.


METHODS
: Twenty three patients were involved in this study. Seventeen patients had intraoperative CSF leakage and were treated immediately by our technique. Six patients had postoperative CSF rhinorrhea and had delayed treatment with our technique after failure of conservative measures and external lumbar CSF drainage for more than three days. The technique involved intradural placement of autologous muscle graft supplemented with extradural composite septal cartilage graft, composed of a piece of the posterior cartilaginous septum with its covering mucoperichondrium on one side only to fit into the sellar defect as a double layer button.


RESULTS
CSF leak was of grade 1 in 6 patients (26.1%), grade 2 in 10 patients (43.5%) and grade 3 in 7 patients (30.4%). None of the patients in our study had postoperative CSF leak after the use of our technique during the follow up period (mean 24 ± 10.47 standard deviation months). None of the patients developed treatment-related complications. All the patients had well developed mucosal covering of the sellar defect after two months.


CONCLUSIONS
Our technique of sellar repair by using autologous muscle and composite septal cartilage grafts is effective in treatment of intraoperative and delayed postoperative CSF leakage following trans-sphenoidal pituitary surgery without the use of postoperative external lumbar CSF drain even in the high-output CSF leaks.
Department of Neurosurgery, Ain Shams University, Ramses Extension Road, Abbasia Square, Cairo, Egypt.
Ayman A
AA
El Shazly
Department of Neurosurgery, Ain Shams University, Ramses Extension Road, Abbasia Square, Cairo, Egypt.
Mohammed A
MA
El Wardany
Department of Otorhinolaryngology, Ain Shams University, Ramses Extension Road, Abbasia Square, Cairo, Egypt.
Tamer A
TA
Abo El Ezz
Cerebrospinal fluid rhinorrhea; composite septal cartilage; pituitary adenoma; sella; trans-sphenoidal
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