The use of the nasoseptal flap to reduce the rate of post-operative cerebrospinal fluid leaks following endoscopic trans-sphenoidal surgery for pituitary disease. (December 2013)

• Record Type: Journal Article
• Authors: Horridge, M.; Jesurasa, A.; Olubajo, F.; Mirza, S.; Sinha, S.
• Is Part Of: British journal of neurosurgery. Volume 27:Number 6(2013:Dec.)
• Page Start: 739
• Page End: 741
• Publication Date: 2013-12
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48
• DOI: 10.3109/02688697.2013.795525
• Languages: English
• ISSNs: 0268-8697

Abstract

<abstract> <title>Abstract</title> <p> <italic>Introduction</italic>. Our aim was to evaluate the routine use of a pedicled nasoseptal flap (NSF) as a primary repair for intra-operative CSF leaks compared with fat/fascia lata graft and lumbar drain insertion by performing a retrospective review of elective patients undergoing primary trans-sphenoidal surgery from January 2008 to present. <italic>Materials and methods</italic>. A retrospective review of consecutive primary elective trans-sphenoidal cases for sellar pathology was undertaken. Prior to September 2009, microscopic trans-sphenoidal surgery (MTSS) was performed in 40 cases and since then endoscopic trans-sphenoidal surgery (ETSS) was performed in 100 cases. <italic>Results and analysis</italic>. In the MTSS group, intra-operative CSF leaks were repaired with fat graft, tisseal and lumbar drain insertion. Intra-operative leaks in the ETSS group were routinely repaired with a pedicled NSF. Post-operative CSF leak rates were 12.5% in the MTSS and 3% in the ETSS groups, respectively. Three patients in the ETSS group developed a post-op CSF leak. All of these patients underwent surgery for craniopharyngiomas. This group had subsequent endoscopic repairs and were managed with repositioning of the NSF. <italic>Conclusion</italic>. The advent of the pedicled NSF conveys a significant advantage in preventing post-operative CSF leak, decreasing the morbidity associated with lumbar drain insertion and reduces the length of hospital stay.</p> </abstract>