Article
Microscopic transsphenoidal pituitary surgery: Collagen sponge coated with activated thrombin and fibrinogen versus Fascia lata as a treatment option for intraoperative cerebro-spinal fluid fistulas
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Published: | May 21, 2013 |
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Objective: Intraoperative cerebro-spinal fluid (CSF) fistula is a well-known problem during transsphenoidal pituitary surgery. Meticulous repair of the defect in the diaphragm and the sellar floor is mandatory using either periumbilical fat, a fascial graft, or a collagen sponge coated with activated thrombin and fibrinogen and fibrin glue. We compare the outcome of leak repair either with Fascia lata or the coated collagen sponge.
Method: During June 2007 and August 2012 we operated on 202 patients by a transsphenoidal approach due to a pituitary lesion. Intraoperative CSF leak repair was performed either with a fascia lata patch or a collagen sponge coated with activated thrombin and fibrinogen and fibrin glue depending on the surgeon's choice. Outcome and revision rate was retrospectively reviewed in this consecutive series.
Results: In our series of 202 consecutive operated patients with microscopic transsphenoidal pituitary surgery, 25 patients (12.4%) had an intraoperative CSF fistula. 10 patients (5.0%) were patched with a fascial graft and fibrin glue and 15 patients (7.4%) got a leak repair with the coated collagen sponge and fibrin glue. All patients were additionally treated with lumbar drain. One patient with a fascial graft suffered from CSF rhinorrhea postoperatively, and none of these patients had local wound problems. 2 patients treated with the collagen sponge needed further surgery due to a persistent CSF leak.
Conclusions: Outcome and revision rate of patients with intraoperative CSF leak repair either with fascia lata or a collagen sponge was identical in both groups. The collagen sponge is a potential treatment option avoiding an additional wound site.