Unique Application of a known Technique: Use of Abdominal Dermal-Fat Grafts in Dural Reconstruction after Transsphenoidal Surgery for those with Intraoperative CSF Leaks

Objective: Unique application of a known technique: Use of abdominal dermal-fat grafts in dural reconstruction after transsphenoidal surgery for those with intraoperative CSF leaks.

Introduction: This is a technique that is well known and historically used in TMJ surgery and ophthalmological surgery. Gaynor et al, demonstrated that use of Alloderm (A commercially available dermal matrix) can be used during transsphenoidal surgery to repair the dura of a low-flow CSF leak with similar, if not improved rates of CSF leak. The benefit of an autologous dermal-fat graft would be that it is native tissue to the patient and seems to be more robust and may provide more support for high-flow CSF leaks. To our knowledge, there have been no reports of dermal-fat grafts being used in transsphenoidal surgeries at this time.

Technique: A biconvex incision is made just inferior to the umbilicus. The epidermis is separated from the underlying dermis with a scalpel. The dermis is then inspected to ensure no residual epidermal tissue is seen. The dermis is then incised and the underlying fat is removed en bloc with the dermis. The fat graft is then trimmed to the appropriate size and placed in the dural defect. This technique can be used on its own with nasal packing or in conjunction with a nasoseptal flap.

Conclusion: This technique is a slight variation in comparison to the standard fat graft. The dermal attachment gives the graft a more controlled structure and adds a strength layer that allows more support. This seems to be well tolerated and can be used to repair high-flow intraoperative CSF leaks. This is a technique we have used more recently and we will report on our results of CSF leaks compared with our previous standard leaks rates to determine if there are any significant differences, especially in the high-flow leak population.