gms | German Medical Science

Objective: Transsphenoidal surgery is a common procedure in patients suffering from pituitary adenomas. Several techniques have been previously postulated to achieve sufficient postoperative sellar reconstruction to avoid cerebrospinal fluid (CSF) leakage. We analyzed our institutional database concerning two techniques of sellar reconstruction and the postoperative development of CSF leakage.

Methods: From 2009 to 2015, 255 patients with pituitary adenoma were treated via transsphenoidal approach at our institution. Information, including patient characteristics, treatment modality, radiological and endocrinological features, length of hospital stay, modality of sellar reconstruction, and presence of postoperative CSF leak were collected and further analyzed. According to the technique used for sellar reconstruction, patients were divided into two groups: 1) with fibrin glue alone and 2) with additional autologous muscle patch.

Results: Overall, postoperative CSF leakage occurred in 7% of the patients. However, occurrence of postoperative CSF leakage did not differ significantly between both sellar reconstruction techniques (p=0.2). Nevertheless, patients who underwent sellar reconstruction with fibrin glue alone had a significantly shorter length of hospital stay (p=0.01) as well as significantly shorter duration of the surgical procedure (p<0.0001). On multivariate analysis, occurrence of intraoperative CSF leakage was the only predictor for postoperative CSF leakage (p<0.0001).

Conclusion: The present data suggest that sellar reconstruction after transsphenoidal pituitary surgery seems to be equally effective in preventing postoperative CSF leakage. However, the use of fibrin glue alone as sellar reconstruction results in shorter hospital stay and operating time without exposing patients to more frequent CSF leakage.