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J Neurol Surg B Skull Base 2023; 84(02): 143-156
DOI: 10.1055/a-1757-3069
Original Article

Fat in the Fossa and the Sphenoid Sinus: A Simple and Effective Solution to CSF Leaks in Transsphenoidal Surgery. Cohort Study and Systematic Review

Asfand Baig Mirza 
1   Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
,
Timothy Boardman
2   GKT School of Medical Education, King's College London, London, United Kingdom
,
Mohamed Okasha
1   Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
,
Hazem Mohamed El-Hariri
3   Community Medicine Department, National Research Centre, Cairo, Egypt
,
Qusai Al Banna
1   Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
,
Christoforos Syrris
1   Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
,
Kaumal Baig Mirza
4   Department of Medicine, Trinity College, Dublin, Ireland
,
Amisha Vastani
1   Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
,
Ravindran Visagan 
1   Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
,
Jonathan Shapey
1   Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
5   Department of Surgical and Interventional Engineering, School of Biomedical Engineering and Imaging Science, King's College London, United Kingdom
,
Eleni Maratos
1   Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
,
Sinan Barazi
1   Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
,
Nick Thomas
1   Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
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Abstract

Objectives Cerebrospinal fluid (CSF) leak following endoscopic transsphenoidal surgery (TSS) remains a challenge and is associated with high morbidity. We perform a primary repair with fat in the pituitary fossa and further fat in the sphenoid sinus (FFS). We compare the efficacy of this FFS technique with other repair methods and perform a systematic review.

Design, Patients, and Methods This is a retrospective analysis of patients undergoing standard TSS from 2009 to 2020, comparing the incidence of significant postoperative CSF rhinorrhea (requiring intervention) using the FFS technique compared with other intraoperative repair strategies. Systematic review of current repair methods described in the literature was performed following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.

Results In all, there were 439 patients, with 276 patients undergoing multilayer repair, 68 patients FFS repair, and 95 patients no repair. No significant differences were observed in baseline demographics between the groups. Postoperative CSF leak requiring intervention was significantly lower in the FFS repair group (4.4%) compared with the multilayer (20.3%) and no repair groups (12.6%, p < 0.01). This translated to fewer reoperations (2.9% FFS vs. 13.4% multilayer vs. 8.4% no repair, p < 0.05), fewer lumbar drains (2.9% FFS vs. 15.6% multilayer vs. 5.3% no repair, p < 0.01), and shorter hospital stay (median days: 4 [3–7] FFS vs. 6 (5–10) multilayer vs. 5 (3–7) no repair, p < 0.01). Risk factors for postoperative leak included female gender, perioperative lumbar drain, and intraoperative leak.

Conclusion Autologous fat on fat graft for standard endoscopic transsphenoidal approach effectively reduces the risk of significant postoperative CSF leak with reduced reoperation and shorter hospital stay.

Keywords

transsphenoidal - endoscopic - CSF leak - repair - sellar - fat graft

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


For this type of study formal, consent is not required.




Publication History

Received: 29 September 2021

Accepted: 30 January 2022

Accepted Manuscript online:
01 February 2022

Article published online:
08 June 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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