Volume 27, Issue 4 (Published 8 October 2013)                   Med J Islam Repub Iran 2013 | Back to browse issues page

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Endoscopic Pituitary and Skull Base Surgery Unit, ENT-Head and Neck Surgery Research Center and Department, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran, and Neurosurgery Department, Loghman Hakim Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. , gsharifimd@gmail.com
Abstract:   (3152 Views)

Background: Proposing a strategy for sellar reconstruction in endoscopic transsphenoidal transsellar approach for pituitary adenoma.


Methods: 240 patients with pituitary adenoma underwent pure endoscopic endonasal transsphenoidal surgery. Intra-operative CSF leaks were classified as grade 0, no observable leak grade 1, CSF dripping through an arachnoid membrane defect of less than 1 mm and grade 2, CSF flowing through an arachnoid defect of more than 1 mm. Sellar reconstruction was performed according to our staging system in stage I, the defect was covered with oxidized cellulose and sphenoid sinus filled up with Gelfoam. In stage II, a layer of fat was applied on the defect and fascia lata placed epidurally. In stage III, one or two layers of fascia were used with adding surgical glue and/or lumbar drainage. Mucosa of sphenoid sinuses was kept intact as much as possible and approximated at the end of procedure.


Result: intra-operative CSF leaks grade 0, 1 and 2 resulted in 133(55.4%), 78 (32.5%) and 29(12.1%) patients, respectively. Stage I of reconstruction was used in 126 patients (52.5%) with no intra-operative CSF leak or sever prolapse of arachnoid membrane. Stage II was performed in 80 patients (33.3%) with either leak grade 1 (73 patients) or grade 0 with severe prolapse of the suprasellar components induced in the sella (2 cases) or in whom extra-pseudocapsular dissection performed (5 cases). Stage III was performed in 34 cases (14.2%) with either CSF leak grade 2 (29 patients) or grade 1 with simultaneous severe destruction or removal of sellar floor laterally, superiorly or inferiorly (5 patients) which made it impossible to place the fascia underlay to the bone. A minimum of 18 months follow-up showed development of 2 CSF leaks (0.8%), one pneumocephalus (0.4%) and 2 meningitis (0.8%) cases.


Conclusion: Given the low postoperative CSF leak rate, we demonstrated that our adopted sellar reconstruction strategy focusing mostly on the adopted intra-operative CSF leak grading system is safe and useful for overcoming devastating complications like postoperative CSF leaks.

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Type of Study: Original Research | Subject: Neurosurgery