Abstract
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.
Keywords
endoscopic - pituitary surgery - cerebrospinal fluid leak - skull base surgery
