Objective Sellar repair techniques with varying complexity and effectiveness have been employed to reduce the incidence of postoperative cerebrospinal fluid (CSF) leaks following endoscopic transsphenoidal pituitary surgery. This study describes our institutional experience with a minimalistic, highly effective approach to sellar repair. Methods The authors performed a retrospective review of consecutive cases of transsphenoidal pituitary surgery performed at our institution. All included subjects underwent sellar repair with an epidural interlay graft. Relationships between patient and tumor characteristics, incidence of CSF leak, adjunct repair techniques, and endocrine outcomes were examined. Results Three hundred and thirty-four (334) cases were included. Intraoperative CSF leak was encountered in 116 cases (34.7%), and postoperative CSF leak occurred only once (0.3%) early in the series. Seventy intraoperative CSF leaks were successfully repaired with an epidural interlay alone, including 13 high-flow leaks. Our rate of fat graft use (1.2%), nasoseptal flap (3.0%), and lumbar drain placement (6.6%) in the second half of the series showed a significant decline compared with the first half, indicating increased reliance on the interlay graft over time. Our 65% functional macroadenoma remission rate compares favorably with large historical series. Conclusions Simple sellar repair using an epidural interlay graft is highly effective in preventing postoperative CSF leaks, including cases of high-flow intraoperative leaks. More complex repair techniques are reserved for select high-risk cases or those with inadequate sellar bony ledges. With this technique, there has been no postoperative CSF leak at our institution in over 300 consecutive transsphenoidal pituitary surgeries.

中文翻译：

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用于垂体手术的硬膜外移植物：4 年机构经验

目的 不同复杂性和有效性的鞍区修复技术已被用来减少内镜经蝶垂体手术术后脑脊液（CSF）漏的发生率。这项研究描述了我们采用简约、高效的鞍区修复方法的机构经验。方法 作者对我院连续进行的经蝶垂体手术病例进行了回顾性分析。所有纳入的受试者均接受了硬膜外夹层移植术的鞍区修复术。研究人员检查了患者与肿瘤特征、脑脊液漏发生率、辅助修复技术和内分泌结果之间的关系。结果 纳入三百三十四（334）例病例。术中出现脑脊液漏 116 例（34.7%），术后脑脊液漏在系列早期仅发生一次（0.3%）。仅使用硬膜外夹层成功修复了 70 例术中脑脊液漏，其中包括 13 例高流量漏。系列后半期的脂肪移植使用率（1.2%）、鼻中隔皮瓣使用率（3.0%）和腰椎引流置入率（6.6%）较前半期显着下降，表明对夹层移植物的依赖增加随着时间的推移。我们 65% 的功能性大腺瘤缓解率与大型历史系列相比毫不逊色。结论 使用硬膜外夹层移植物进行简单的鞍区修复对于预防术后脑脊液漏（包括术中高流量漏的情况）非常有效。更复杂的修复技术是为选定的高风险病例或鞍骨台不足的病例保留的。通过该技术，我院连续300余例经蝶垂体手术中未出现术后脑脊液漏。