Suprasellar Approaches: New Techniques and Old Tricks for Cerebrospinal Fluid Leaks

Abstract

ascarenhas et al. elegantly summarize their surgical experience with a total of 122 patients, done in a M two-stage report, the first part a total of 63 patients were included and the second had 59 patients. The patients underwent to a transsphenoidal transplanum sphenoidale approach for sellar and suprasellar region tumors. The article focused on complication incidence and proves that the learning curve is an important factor for success for this complex approach. Results from the first group showed four patients with cerebrospinal fluid (CSF) leak, the rest of the patients did not experience any other complication. Mascarenhas et al. describe the development a packing technique using fascia, contained by a plaque of porous polyethylene (Medpore [Stryker Corporation, Kalamazoo, Michigan, USA]), covered by a nasoseptal pedicle flap, and finally all covered with fibrin sealant. Using this novel packing technique, they report 0 incidence of CSF leak. The tumors treated by the approach included pituitary adenomas (51.6%), craneopharingioma (20.6%), and meningiomas (15.9%). The main symptom was visual disturbances in 73% of the cohort. Patient selection has an extra credit from my point of view, proving that the learning curve has a direct influence in patient outcome using this novel approach.