Efficacy and Safety of Different Grafting Types in Endoscopic Sellar Repair

Abstract

ABSTRACT Background: Postoperative CSF leakage is one of the most common complications after pituitary adenoma resection by endoscopic endonasal transsphenoidal approach (0.6%–3.5%). Sellar reconstruction has been postulated as a crucial step in this approach to overcome such complications. Aim of the work : to evaluate the efficacy and safety of different grafting types and factors that determine which sellar repair is needed according to the size of arachnoid defect or CSF flow. Patients and methods: Retrospective study included 32 patients at Al azhar university hospitals who underwent endoscopic endonasal sellar repair (EER) with different grafting types after pituitary surgery. 14 patients repair with fascia lata graft, 12 patients with dural substitute (Duragen Integra LifeSciences Corp, USA) and 6 patients vascularized nasoseptal flap. Results: the mean age was (33.68 ± 10.2) years, with (59.4%) females and (40.6%) males. Regarding post-operative complications; (21.9%) of patients had CSF leakage, (6.2%) had epistaxis and sinusitis, (9.4%) had pneumocephalus, and the overall complications rate was (34.4%), with success rate (78.1%), and failure rate (21.9%). On comparing the 3 grpups, seven patients (21.9%) had repair failure and required re-operation for repair of persistent CSF leak and need recurrent sellar repair, 4 patients (12.5%) from fascia lata group and 3 patients (9.3%) from dural substitute group. Conclusion: vascularized nasoseptal flap is effective as regards success rate, repair failure and complications rates. The other types (fascia lata and dural substitute) are effective and safe with low CSF leakage rates. Keywords: Cerebrospinal Fluid Leak; Endoscopic Endonasal; Reconstructions.