Cerebrospinal fluid leaks after transsphenoidal surgical procedure – Impact of a polyethylene glycol hydrogel dural sealant.
J Clin Neurosci. 2017 Oct;44:6-10
Authors: Pereira EAC, Grandidge CA, Nowak VA, Cudlip SA
To analyze cerebrospinal fluid (CSF) leak charges after primarily endoscopic endonasal transsphenoidal surgical procedure with and with out polyethylene glycol hydrogel dural sealant (DuraSeal®), we prospectively collected information from a single-centre consecutive case sequence over 4 years from January 2007 to December 2010 inclusive. 250 sufferers have been recognized (135 male, 115 feminine; median age 52years, vary 14-83). 180 sufferers acquired DuraSeal® (72%). 85 (34%) had intra-operative dural breach and 13 (5.2%) developed post-operative CSF leaks (three with out intra-operative dural breach) requiring lumbar drainage or formal restore. Of this group 5/251 (2.zero%) sufferers required a proper restore. Submit-operative CSF leak was seen in 5/189 (2.7%) of sufferers with pituitary adenoma, of which 2/5 (40%) have been in instances present process revision surgical procedure. 5/13 (38.four%) sufferers who developed a CSF leak introduced with both Rathke’s cleft cyst or craniopharyngioma. three/71 sufferers not receiving DuraSeal® leaked (four.2%) and 10/180 sufferers receiving DuraSeal® leaked (5.6%). 11/234 sufferers with out Tisseel (four.7%) and a couple of/16 receiving Tisseel (12.5%) leaked. 54 sufferers (22%) acquired intra-operative lumbar drains, certainly one of whom developed subsequent CSF leak (1.9%), in distinction to 12/197 (6.1%) of sufferers with out intra-operative lumbar drains who later developed CSF leak. The speed of post-operative CSF leak requiring re-exploration and nasoseptal flap restore was low (2.zero%) on this primarily endoscopic case sequence with out statistically vital profit from both DuraSeal® or Tisseel. Intra-operative and post-operative lumbar drainage seems helpful in sufferers at larger danger of post-operative CSF leak.
PMID: 28676314 [PubMed – indexed for MEDLINE]