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; Timothy Boardman; Mohamed Okasha; Hazem Mohamed El-Hariri; Qusai Al Banna; Christoforos Syrris; Kaumal Baig Mirza; Amisha Vastani; Ravindran Visagan; Jonathan Shapey; Eleni Maratos; Sinan Barazi; Nick Thomas

doi:10.1055/a-1757-3069

Journal of Neurological Surgery Part B: Skull Base, Inhaltsverzeichnis

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

¹Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom

,

Timothy Boardman

²GKT School of Medical Education, King's College London, London, United Kingdom

,

Mohamed Okasha

¹Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom

,

Hazem Mohamed El-Hariri

³Community Medicine Department, National Research Centre, Cairo, Egypt

,

Qusai Al Banna

¹Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom

,

Christoforos Syrris

¹Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom

,

Kaumal Baig Mirza

⁴Department of Medicine, Trinity College, Dublin, Ireland

,

Amisha Vastani

¹Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom

,

Ravindran Visagan

¹Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom

,

Jonathan Shapey

¹Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom

⁵Department of Surgical and Interventional Engineering, School of Biomedical Engineering and Imaging Science, King's College London, United Kingdom

,

Eleni Maratos

¹Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom

,

Sinan Barazi

¹Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom

,

Nick Thomas

¹Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom

› Institutsangaben

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

Volltext

Referenzen

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