Surgical Repair of Skull Base Defect Following Standard or Extended Endoscopic Transsphenoidal Surgery for Pituitary Tumors

Introduction: The aim this study was to describe our strategy in CSF leak plastic repair after endoscopic endonasal surgery.

Methods: Between 1998 and 2011, 1240 patients underwent endonasal endoscopic surgery for pituitary and skull base tumors. In patients without intraoperative CSF leak, we prefer to pack the surgical cavity with absorbable material. In case of a thin diaphragma sellae or minimal CSF oozing, but without any visible diaphragma sellae defect or even in presence of a small leak, the abdominal fat is generally preferred. In case of a leak from an anterior face of the diaphragma sellae defect, we generally use mucoperiosteum taken from the middle turbinate and pack the sella with fat as well. For larger sellar or supradiaphragmatic defects, however, repair is usually done via multilayer reconstruction.

Results: Of the 1240 patients, 836 (67%) did not require any repair besides a packing of the surgical cavity with absorbable material, and 327 patients (26%) required an endoscopic skull base repair for an overt CSF leak. Seventy-seven patients (6%) required repair because of a thin diaphragma sellae but without any visible CSF leak. Thirty-eight patients (3%) developed postoperative CSF leak requiring a revision multilayer reconstruction. The different strategies related to the different pathologies and approaches will be described.

Conclusions: Complex defects after pituitary surgery should be repaired with a multilayer technique, using autologous materials such as fat, fascia lata, bone, and mucoperiosteum taken from the middle turbinate. This type of autologous material is generally reliable in complex skull base defect repair. Moreover, the autologous material appears to be easy to handle for repair.