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J Neurol Surg B Skull Base
DOI: 10.1055/a-2175-8181
Original Article

Epidural Interlay Graft for Pituitary Surgery: A 4-Year Institutional Experience

Rita Snyder
1   Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
,
Sungho Lee
2   Department of Neurosurgery, Louisiana State University, Shreveport, Luisiana, United States
,
Prazwal Athukuri
1   Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
,
Emmeline Monique Tan Ngo
3   Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
,
Meha Goyal Fox
4   Department of Otolaryngology, Baylor College of Medicine, Houston, Texas, United States
,
Samer Fakhri
5   Section of Otolaryngology, Kelsey-Seybold Clinic, Houston, Texas, United States
,
Masayoshi Takashima
6   Department of Otolaryngology, Houston Methodist, Houston, Texas, United States
,
Bahar Kapoor Force
3   Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
,
Susan Leanne Samson
7   Departments of Medicine and Neurological Surgery, Mayo Clinic, Jacksonville, Florida, United States
,
Kathleen Kelly Gallagher
4   Department of Otolaryngology, Baylor College of Medicine, Houston, Texas, United States
,
Daniel Yoshor
8   Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Ali Jalali
1   Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
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Abstract

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.

Keywords

endoscopic transsphenoidal - pituitary adenoma - pituitary surgery - sellar repair - cerebrospinal fluid leak - nasoseptal flap


Publication History

Received: 07 July 2023

Accepted: 12 September 2023

Accepted Manuscript online:
14 September 2023

Article published online:
08 November 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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