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64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

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Microscopic transsphenoidal pituitary surgery: Collagen sponge coated with activated thrombin and fibrinogen versus Fascia lata as a treatment option for intraoperative cerebro-spinal fluid fistulas

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  • Dominique Kuhlen - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
  • Jürgen Kreutzer - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
  • Jens Lehmberg - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
  • Michael Stoffel - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
  • Florian Ringel - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
  • Karine Sahakyan - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
  • Bernhard Meyer - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, TU München

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMO.04.05

doi: 10.3205/13dgnc033, urn:nbn:de:0183-13dgnc0330

Published: May 21, 2013

© 2013 Kuhlen et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Intraoperative cerebro-spinal fluid (CSF) fistula is a well-known problem during transsphenoidal pituitary surgery. Meticulous repair of the defect in the diaphragm and the sellar floor is mandatory using either periumbilical fat, a fascial graft, or a collagen sponge coated with activated thrombin and fibrinogen and fibrin glue. We compare the outcome of leak repair either with Fascia lata or the coated collagen sponge.

Method: During June 2007 and August 2012 we operated on 202 patients by a transsphenoidal approach due to a pituitary lesion. Intraoperative CSF leak repair was performed either with a fascia lata patch or a collagen sponge coated with activated thrombin and fibrinogen and fibrin glue depending on the surgeon's choice. Outcome and revision rate was retrospectively reviewed in this consecutive series.

Results: In our series of 202 consecutive operated patients with microscopic transsphenoidal pituitary surgery, 25 patients (12.4%) had an intraoperative CSF fistula. 10 patients (5.0%) were patched with a fascial graft and fibrin glue and 15 patients (7.4%) got a leak repair with the coated collagen sponge and fibrin glue. All patients were additionally treated with lumbar drain. One patient with a fascial graft suffered from CSF rhinorrhea postoperatively, and none of these patients had local wound problems. 2 patients treated with the collagen sponge needed further surgery due to a persistent CSF leak.

Conclusions: Outcome and revision rate of patients with intraoperative CSF leak repair either with fascia lata or a collagen sponge was identical in both groups. The collagen sponge is a potential treatment option avoiding an additional wound site.