Skull Base 2011; 21(1): 047-052
DOI: 10.1055/s-0030-1263281

© Thieme Medical Publishers

Primary Closure of a Cerebrospinal Fluid Fistula by Nonpenetrating Titanium Clips in Endoscopic Endonasal Transsphenoidal Surgery: Technical Note

Hiroyuki Kobayashi1 , Katsuyuki Asaoka2 , Shunsuke Terasaka1 , Jun-ich Murata3
  • 1Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
  • 2Department of Neurosurgery, Teine Keijinkai Medical Center, Sapporo, Japan
  • 3Asabu Neurosurgical Hospital, Sapporo, Japan
Further Information

Publication History

Publication Date:
06 August 2010 (online)


Postoperative cerebrospinal fluid (CSF) leakage is one of the most common and aggravating complications in transsphenoidal surgery. Although primary closure of the fistula would be the most desirable solution for an intraoperatively encountered CSF leak, it is difficult to achieve in such a deep and narrow operative field. In this article, the authors report endonasal endoscopic applications of no-penetrating titanium clips to repair a CSF fistula following tumor removal. The AnastoClip Vessel Closure System (VCS; LeMaitre Vascular, Boston, MA) was used for closure of a CSF fistula in endonasal transsphenoidal surgery. In all four patients, CSF leakage was successfully obliterated primarily with two to five clips. There was no postoperative CSF rhinorrhea or complications related to the use of the VCS. Metal artifact by the clips on postoperative images was tolerable. Primary closure of the fistula using the VCS was an effective strategy to prevent postoperative CSF leakage in transsphenoidal surgery. Future application can be expanded to reconstruction of the skull base dura via endonasal skull base approaches.


Hiroyuki Kobayashi, M.D. 

Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North

15, West 7, Kita-Ku, Sapporo, Japan