J Neurol Surg A Cent Eur Neurosurg 2013; 74(05): 313-317
DOI: 10.1055/s-0032-1333129
Technical Note
Georg Thieme Verlag KG Stuttgart · New York

Complex Reconstruction of the Sella Using Absorbable Mini-Plate in Revision Endoscopic Pituitary Surgery: Technical Note

Abtin Tabaee
1   Department of Otolaryngology, Head and Neck Surgery, Beth Israel Medical Center, New York, New York, United States
Ameet Kamat
1   Department of Otolaryngology, Head and Neck Surgery, Beth Israel Medical Center, New York, New York, United States
Raj Shrivastava
2   Department of Neurosurgery, Beth Israel Medical Center, New York, New York, United States
› Author Affiliations
Further Information

Publication History

13 September 2011

20 August 2012

Publication Date:
26 March 2013 (online)


Background Skull base reconstruction in the setting of revision endoscopic pituitary surgery with intraoperative cerebrospinal fluid (CSF) leak represents a unique challenge.

Materials and Methods The demographics and outcomes of four patients undergoing revision endoscopic pituitary surgery with high-volume intraoperative CSF leak are described. The “gasket-seal” technique of sellar repair using bioabsorbable mini-plate is described.

Results The indications for surgery were macroadenoma with suprasellar extension and optic nerve compression in three patients and growth hormone–secreting tumor in one patient with acromegaly. The multilayered reconstruction consisted of autologous fat placed in the tumor cavity followed by reconstruction of the sellar floor with an oversized sheet of either fascia lata or acellular dermal matrix placed over the skull base defect and sunken into the sella with a bioabsorbable mini-plate. One patient experienced postoperative CSF leak on postoperative day 2 that resolved with lumbar drainage alone. All patients were noted to have a well mucosalized sphenoid sinus and were free of CSF leak at last follow-up.

Conclusion Sellar reconstruction following endoscopic pituitary surgery represents a technical challenge, especially in revision cases with high-volume intraoperative CSF leak. The early experience with the “gasket-seal” closure using the bioabsorbable mini-plate appears favorable. Lumbar drain may be indicated in patients with postoperative CSF leak.


Paper presented at Rhinology World meeting, Philadelphia, PA, April 2009.

  • References

  • 1 Tabaee A, Anand VK, Barrón Y , et al. Endoscopic pituitary surgery: a systematic review and meta-analysis. J Neurosurg 2009; 111: 545-554
  • 2 Cappabianca P, Cavallo LM, de Divitiis E. Endoscopic endonasal transsphenoidal surgery. Neurosurgery 2004; 55: 933-940 , discussion 940–941
  • 3 Tabaee A, Anand VK, Brown SM, Lin JW, Schwartz TH. Algorithm for reconstruction after endoscopic pituitary and skull base surgery. Laryngoscope 2007; 117: 1133-1137
  • 4 Cappabianca P, Cavallo LM, Esposito F, Valente V, De Divitiis E. Sellar repair in endoscopic endonasal transsphenoidal surgery: results of 170 cases. Neurosurgery 2002; 51: 1365-1371 , discussion 1371–1372
  • 5 Shiley SG, Limonadi F, Delashaw JB , et al. Incidence, etiology, and management of cerebrospinal fluid leaks following trans-sphenoidal surgery. Laryngoscope 2003; 113: 1283-1288
  • 6 Leng LZ, Brown S, Anand VK, Schwartz TH. “Gasket-seal” watertight closure in minimal-access endoscopic cranial base surgery. Neurosurgery 2008; 62 (5) (Suppl. 02) E342-E343 , discussion E343
  • 7 Kassam AB, Thomas A, Carrau RL , et al. Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 2008; 63 (1) (Suppl. 01) ONS44-ONS52 , discussion ONS52–ONS53
  • 8 Kabuto M, Kubota T, Kobayashi H , et al. Long-term evaluation of reconstruction of the sellar floor with a silicone plate in transsphenoidal surgery. J Neurosurg 1998; 88: 949-953
  • 9 Cappabianca P, Cavallo LM, Mariniello G, de Divitiis O, Romero AD, de Divitiis E. Easy sellar reconstruction in endoscopic endonasal transsphenoidal surgery with polyester-silicone dural substitute and fibrin glue: technical note. Neurosurgery 2001; 49: 473-475 , discussion 475–476
  • 10 Fraser JF, Nyquist GG, Moore N, Anand VK, Schwartz TH. Endoscopic endonasal minimal access approach to the clivus: case series and technical nuances. Neurosurgery 2010; 67 (3, Suppl Operative): ons150-ons158 , discussion ons158
  • 11 Snyderman CH, Kassam AB, Carrau R, Mintz A. Endoscopic reconstruction of cranial base defects following endonasal skull base surgery. Skull Base 2007; 17: 73-78