Direct Suture Technique of Normal Gland Edge on the Incised Dura Margin to Repair the Intraoperative Cerebrospinal Fluid Leakage From the Arachnoid Recess During Transsphenoidal Pituitary Tumor Surgery. Issue 1 (March 2015)

• Record Type: Journal Article
• Authors: Kim, Eui Hyun; Roh, Tae Hoon; Park, Hun Ho; Moon, Ju Hyung; Hong, Je Beom; Kim, Sun Ho
• Is Part Of: Operative neurosurgery. Volume 11:Issue 1(2015)
• Publication Date: 2015-03
• Subjects: Arachnoid recess repair -- Cerebrospinal fluid leakage -- Pituitary adenoma -- Suture technique -- Transsphenoidal surgery; Nervous system -- Surgery -- Periodicals; 617.480590
• DOI: 10.1227/NEU.0000000000000612
• Languages: English
• ISSNs: 2332-4252

Abstract

Abstract : BACKGROUND: During transsphenoidal surgery for pituitary adenomas with large suprasellar extension, cerebrospinal fluid (CSF) leakage commonly develops from a defect at the arachnoid recess between the resected dura margin and the anterior edge of a normal pituitary gland (type 1 CSF leakage). OBJECTIVE: To evaluate the usefulness of a direct suture technique of the normal gland edge on the incised dural margin to repair intraoperative CSF leakage from the arachnoid recess. METHODS: Between November 2005 and December 2012, 861 patients with pituitary adenomas were operated on with transsphenoidal surgery, and intraoperative CSF leakage was encountered in 432 patients. Type 1 CSF leakage developed in a total of 122 patients, and their defects were repaired with the direct suture technique in 51 patients, whereas a fleece-coated fibrin glue patch alone was applied onto the defect in the other 71 patients. This direct suture technique required an additional 5 to 20 minutes in most cases. RESULTS: We experienced no case of postoperative CSF rhinorrhea in the 51 patients whose defects were repaired by the direct suture technique and only 1 case of CSF rhinorrhea in 71 patients whose defects were repaired with a fleece-coated fibrin glue patch alone. There was no statistical difference in the outcome between 2 groups. Postoperative lumbar CSF drainage was not performed in any case. CONCLUSION: Our 2 different repair techniques for arachnoid recess tears are very reliable methods for managing this type of CSF leakage. The direct suture technique may be more appropriate for type 1 CSF leakage with a wider gap and more prominent CSF leakage. ABBREVIATION: TSS, transsphenoidal surgery Abstract : Supplemental Digital Content is Available in the Text.