J Neurol Surg B Skull Base
DOI: 10.1055/s-0039-3402000
Original Article
Georg Thieme Verlag KG Stuttgart · New York

A Simple Onlay Sellar Reconstruction Does not Increase the Risk of Postoperative Cerebrospinal Fluid Leak in Well-Selected Patients

Mark B. Chaskes
1  Department of Otolaryngology Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Judd H. Fastenberg
1  Department of Otolaryngology Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Swar Vimawala
1  Department of Otolaryngology Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Gurston F. Nyquist
1  Department of Otolaryngology Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Mindy R. Rabinowitz
1  Department of Otolaryngology Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Chandala Chitguppi
1  Department of Otolaryngology Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Meagan Falls
2  Sidney Kimmel Medical College of Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Tomas Garzon-Muvdi
3  Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Marc R. Rosen
1  Department of Otolaryngology Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
James J. Evans
3  Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
› Author Affiliations
Further Information

Publication History

03 July 2019

10 November 2019

Publication Date:
08 January 2020 (online)

Abstract

Objectives A variety of endonasal sellar repair techniques have been described; many of which are complex, expensive, and carry potential morbidity but are felt to be necessary to prevent postoperative cerebrospinal fluid (CSF) leaks. We propose an effective, technically simple repair for select sellar defects utilizing an onlay of regenerated oxidized cellulose.

Design Retrospective review of patients from a single neurosurgeon who underwent endoscopic transsphenoidal surgery for pituitary adenoma and sellar reconstruction with only an onlay of regenerated oxidized cellulose. Patients were selected for this repair technique based on the absence of: (1) intraoperative identification of a CSF leak, (2) patulous diaphragm (expanded diaphragm sella herniating to or through sellar floor defect), and (3) other prohibiting comorbidities.

Setting The present study was conducted at a tertiary care center.

Participants In this study, pituitary adenoma patients were the participants.

Outcome Measures Main outcome measure of the study is postoperative CSF leak.

Results A total of 172 patients were identified. Of these, 153 were initial resections of pituitary adenomas. Gross total resection was achieved in 142 (82.6%) cases. Average tumor size was 2.2 ± 1.1 cm. Average tumor volume was 10.4 ± 19.8 cm3. No patients had intraoperative CSF leaks. All cases were repaired with only an onlay of regenerated oxidized cellulose. There were two postoperative CSF leaks (1.16%). Pre and postoperative SNOT-22 scores were 12.9 ± 11.9 and 14.3 ± 14.9 (p = 0.796), respectively.

Conclusion The use of an onlay of regenerated oxidized cellulose alone is an effective repair technique for select sellar defects. This technique does not result in increased postoperative CSF leak rates and avoids the higher relative cost and potential morbidity associated with more complex, multilayered closures.