Low-Grade CSF Leaks in Endoscopic Transsphenoidal Pituitary Surgery: Efficacy of a Simple and Fully Synthetic Repair with a Hydrogel Sealant

Objective: Intraoperative CSF leak during endoscopic transsphenoidal surgery is not uncommon. Surgical repair with a variety of autologous grafts, rigid buttresses, and CSF diversion techniques that add time and complexity have been reported. We describe a simple and purely synthetic closure for low-grade CSF leaks following endoscopic transsphenoidal pituitary surgery.

Design: Retrospective study.

Methods: A retrospective review of all endoscopic transsphenoidal surgery undertaken for pituitary pathology between 2005 and 2010 was carried out. The grade of CSF leak and success of graded repair was noted. Patients with no CSF leak (grade 0) had gelatin sponge placed in the tumor cavity. In those with low-grade CSF leak through small arachnoid defects (grade 1), repair was carried out using a gelatin sponge and hydrogel sealant overlay. CSF diversion was not employed for low-grade CSF leaks.

Results: Of the 255 endoscopic transsphenoidal surgeries, 158 (62%) had no leak (grade 0) and 74 (29%) had a low-grade leak (grade 1). Repairs in all cases of grade 0 and all but two cases of grade 1 CSF leak were successful at a mean follow-up of 29 months. The two (2.7%) postoperative CSF leaks were seen within 6 weeks of surgery. Both cases were related to bouts of sneezing and were repaired using further transsphenoidal surgery and/or lumbar CSF diversion.

Conclusions: A simple purely synthetic repair of low-grade CSF leaks is described. This repair is safe and comparable in efficacy, while avoiding the morbidity related to more complex sellar reconstructions previously described.