Closure Methods for the Prevention of CSF Fistula in Transsphenoidal Surgery: A Large Study

Research Article

Abstract

Aim and Background: The primary objective of this extensive series is to conduct a comparative analysis of microscopes and endoscopes and investigate the extent of variability in CSF leakage based on the surgical approach employed, the occurrence of complications during the procedure, the techniques employed for closure, and any postoperative interventions.

Materials and Methods: A retrospective analysis was conducted on lesions in the sellar region that were surgically treated via the transsphenoidal approach in the Department of Neurosurgery. Microscope, endoscope, or both were used during the approach. The access route used in this study was the transnasal transsphenoidal (TNTS), sublabial, or transcranial+TNTS approach. The repair procedure involved the use of a Surgicel-coated nasal flap, fat graft, or fascia graft and fibrin glue.

Results: The cohort of individuals experiencing CSF leaks exhibited a notably elevated use of endoscopic procedures, while the use of microscopic techniques was relatively few. The incidence of fat graft, nothing, fat+fascia, and the presence of surgicel was rather low in patients presenting with CSF leakage. There was no statistically significant disparity observed in the frequencies of lumber puncture among patients who did not exhibit cerebrospinal fluid leakage. The rates of lumber drainage and meningitis were found to be considerably greater in patients with CSF leak compared to those without (p<0.001 for both variables).

Conclusion: It has been suggested that selecting an appropriate closure approach should be based on the intraoperative complications observed during the surgical procedure, to prevent CSF leakage.