A Report of Endoscopic Transsphenoidal Sellar Floor Reconstruction with Resultant Cerebrospinal Fluid Leak Risk and Complication Management

Common postoperative cerebrospinal fluid (CSF) leakage rates range from 1-15%, and intraoperative sellar reconstruction remains controversial with conflict regarding the varying need for dural sealants and autologous packing. Although there are reports in the literature without sellar reconstruction, lumbar drains are often used with intraoperative leaks and result in longer hospital stays. Furthermore, surgery without sellar reconstruction may be less amendable to lumbar drainage secondary to the risk of pneumocephalus, which potentially increases the need for repeat surgery. In this retrospective review of 315 consecutive patients undergoing endoscopic transsphenoidal surgery at a single institution, sellar reconstruction was performed in all patients and consisted of fat packing followed by a fitted intrasellar autologous cartilage graft covered with a dural sealant. CSF leakage occurred in 1.6% of patients with 0.8% postoperatively and 0.8% with a delayed presentation. Successful management consisted of lumbar drainage in all. Complications of the abdominal fat graft included hematoma occurring in 0.6%. Thus, routine sellar reconstruction is both safe and effective, offering a minimal rate of CSF leak and potentially decreasing the need for lumbar drainage and repeat surgery.