Abdominal fat double layers is it enough for sellar reconstruction

BACKGROUND Transsphenoid endoscopic endonasal approach for the sella had now become the state of art for resection of pituitary adenomas. One of the most common and serious postoperative complication is leakage Csf which may have fatal. Different strategies for sellar reconstruction had been described. Autogenous fat is the cheapest and most available material.

OBJECTIVE Assessment of rate of CSF rhinorrhea after endoscopic hypophysectomy, and efficacy of reconstruction t with two layers of abdominal fat graft

METHODS This is a prospective study. Sixty patients who had endonasal endoscopic transsphenoidal approach to sellar lesions were included. Cases with intaoperative CSF leakage were identified and classified; grade 1, grade 2, grade 3 according to size of arachnoid defect.

Repair of the defect was done with two abdominal fat layers; one intradural and the other something through the dural defect.

RESULTS Our study included 60 patients with pituitary adenomas, 31 of them (52 %) had intraoperative CSF leak. Thirty cases reconstructed with double layer abdominal fat. Overall success occurred in 26 cases out of 30 (87 %). Only two cases of 30 (6.6 %) needed revision reconstruction.

Fourteen cases had grade 1 CSF leake in whom success rate was 100 %. Eleven cases had grade 2 CSF leake with 82 % sucsess rate.

Grade 3 CSF leake what reported in 5 cases, with 60 % success

CONCLUSION Double layer abdominal fat reconstruction of the sella is a reliable, easy, cheap, and almost method. It is highly effective in grade 1 and 2 CSF leakage.

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Artikel online veröffentlicht:
10. Juni 2020