Epidural Interlay Graft for Pituitary Surgery: A 4-Year Institutional Experience

Rita Snyder; Sungho Lee; Prazwal Athukuri; Emmeline Monique Tan Ngo; Meha Goyal Fox; Samer Fakhri; Masayoshi Takashima; Bahar Kapoor Force; Susan Leanne Samson; Kathleen Kelly Gallagher; Daniel Yoshor; Ali Jalali

doi:10.1055/a-2175-8181

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2024; 85(S 02): e10-e15
DOI: 10.1055/a-2175-8181

Original Article

Epidural Interlay Graft for Pituitary Surgery: A 4-Year Institutional Experience

Authors

Rita Snyder

¹Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
Sungho Lee

²Department of Neurosurgery, Louisiana State University, Shreveport, Luisiana, United States
Prazwal Athukuri

¹Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
Emmeline Monique Tan Ngo

³Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
Meha Goyal Fox

⁴Department of Otolaryngology, Baylor College of Medicine, Houston, Texas, United States
Samer Fakhri

⁵Section of Otolaryngology, Kelsey-Seybold Clinic, Houston, Texas, United States
Masayoshi Takashima

⁶Department of Otolaryngology, Houston Methodist, Houston, Texas, United States
Bahar Kapoor Force

³Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
Susan Leanne Samson

⁷Departments of Medicine and Neurological Surgery, Mayo Clinic, Jacksonville, Florida, United States
Kathleen Kelly Gallagher

⁴Department of Otolaryngology, Baylor College of Medicine, Houston, Texas, United States
Daniel Yoshor

⁸Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
Ali Jalali

¹Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States

Abstract

Objective Sellar repair techniques with varying complexity and effectiveness have been employed to reduce the incidence of postoperative cerebrospinal fluid (CSF) leaks following endoscopic transsphenoidal pituitary surgery. This study describes our institutional experience with a minimalistic, highly effective approach to sellar repair.

Methods The authors performed a retrospective review of consecutive cases of transsphenoidal pituitary surgery performed at our institution. All included subjects underwent sellar repair with an epidural interlay graft. Relationships between patient and tumor characteristics, incidence of CSF leak, adjunct repair techniques, and endocrine outcomes were examined.

Results Three hundred and thirty-four (334) cases were included. Intraoperative CSF leak was encountered in 116 cases (34.7%), and postoperative CSF leak occurred only once (0.3%) early in the series. Seventy intraoperative CSF leaks were successfully repaired with an epidural interlay alone, including 13 high-flow leaks. Our rate of fat graft use (1.2%), nasoseptal flap (3.0%), and lumbar drain placement (6.6%) in the second half of the series showed a significant decline compared with the first half, indicating increased reliance on the interlay graft over time. Our 65% functional macroadenoma remission rate compares favorably with large historical series.

Conclusion Simple sellar repair using an epidural interlay graft is highly effective in preventing postoperative CSF leaks, including cases of high-flow intraoperative leaks. More complex repair techniques are reserved for select high-risk cases or those with inadequate sellar bony ledges. With this technique, there has been no postoperative CSF leak at our institution in over 300 consecutive transsphenoidal pituitary surgeries.

Keywords

endoscopic transsphenoidal - pituitary adenoma - pituitary surgery - sellar repair - cerebrospinal fluid leak - nasoseptal flap

Full Text

References

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