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KMID : 0942820120110020077
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Journal of Korean Brain Tumor Society
2012 Volume.11 No. 2 p.77 ~ p.82
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Successful Prevention of Cerebrospinal Fluid Leakage after Endoscopic Endonasal Transsphenoidal Surgery
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Park Jun-Sang
Kang Seok-Gu
Hong Yong-Kil
Jeun Sin-Soo
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Abstract
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Objectives: The endoscopic endonasal transsphenoidal approach (EETSA) is increasingly being used to treat pituitary adenomas and other sellar/suprasellar pathologies. One important complication of the transsphenoidal approach is cerebrospinal fluid (CSF) leakage, which occurs in 0.4 to 9% of cases. We report our experience with EETSA and describe the me-thods that we use to prevent CSF leakage.
Methods: A single surgeon performed EETSA on 170 consecutive patients between Feb 2004 and Apr 2011. Patients were divided into three groups based on their CSF leakage status as follows: no CSF leakage, minor CSF leakage, and major CSF leakage. Sellar floor reconstruction was performed according to this classification. In the no-CSF leakage group, sellar floor reconstruction was performed with oxidative cellulose (Surgicel?) only. In the second group (minor CSF leakage), sellar floor reconstruction was performed using autologous fat and bone grafts. Patients in the third group (major CSF leakage) underwent an additional reconstructive procedure of the skull base using the pedicled septal mucosal flap.
Results: Of 170 patients, 30 (17.6%) showed CSF leakage in the operation field ; 24 (14.1%) were classified as having minor CSF leakage and 6 (3.5%) patients were classified as having major CSF leakage. Post-operative CSF leakage occurred in only two cases.
Conclusion: CSF leakage, though relatively common in the operation field, can be prevented effectively with adequate reconstruction techniques. Assignment of patients to one of three groups based on their CSF leakage in the operation field and sellar floor reconstruction based on this classification resulted in favorable postoperative outcomes.
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KEYWORD
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Endoscopic endonasal transsphenoidal surgery, CSF leakage, Sellar floor reconstruction, Pedicled septal mucosal flap
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