Article
A simple sellar closure technique after transsphenoidal resection of pituitary adenomas in the context of risk factors for cerebrospinal fluid (CSF) leaks and meningitis
Eine einfache OP Technik zum Sellaverschluss nach transsphenoidaler Resektion von Hypophysenadenomen im Kontext von Risikofaktoren für Liquorlecks und Meningitis
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Authors
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Moritz Ueberschaer
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Sophie Katzendobler
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Jörg-Christian Tonn
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Jun Thorsteinsdottir
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Walter Rachinger
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
| Published: | May 25, 2022 |
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Outline
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Objective: The transsphenoidal approach is the standard for most pituitary tumors. Despite low morbidity, postoperative cerebrospinal fluid (CSF) fistulas and meningitis are specific complications. Various surgical closure techniques for intraoperative CSF leak (iCSFl) and sellar reconstruction have been described. For many years, we have been using synthetic materials for iCSFl repair and sellar closure in a standardized fashion in our department. Here we analyze the surgical outcome of this management as well as risk factors (RF) for iCSFl and meningitis.
Methods: Retrospectively we screened all patients with transsphenoidal resection of a pituitary adenoma operated by the same surgeon between 01/13 and 12/19. Little intraoperative CSF flow without diaphragmatic defect was classified as “minor leak” and obvious CSF flow with/without diaphragmatic defect was classified as “major leak”. In case of iCSFl, a fibrin/thrombin coated sponge was used to cover the diaphragmatic defect and another one for the sellar opening. A gelatin sponge was placed in the sphenoid sinus as an abutment. Primary/secondary outcome was the number of postoperative CSFl/meningitis. Clinical, histological and perioperative data from medical records were collected to identify RF for CSFl/meningitis.
Results: Of 417 transsphenoidal surgeries, 359 procedures for pituitary adenomas in 348 patients with a median age of 54 years were included. There were 96 (26%) iCSFl leaks (37.5% major, 62.5% minor). In 3 of 359 cases (0.8%) a postoperative CSF fistula occurred requiring revision surgery in two patients and a lumbar drainage in one patient. Meningitis occurred in 3 of 359 cases (0.8%). All 3 patients recovered after antibiotic therapy without sequelae. According to univariate analysis, RF for iCSFl were macroadenoma (p=0.006) and recurrent adenoma (p=0.023). An iCSFl was less often in functioning adenomas (p=0.025). In multivariate analysis recurrent tumors remained as a RF (p=0.021) for iCSFl.
Conclusion: Especially patients with macroadenomas and recurrent adenomas are at risk for iCSFl. Our surgical technique leads to a very low rate of postoperative CSF leaks/meningitis without using autologous graft materials. Hence, this technique is safe and improves patient comfort by avoiding the disadvantages of autologous graft harvesting.
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