The use of the nasoseptal flap to reduce the rate of post-operative cerebrospinal fluid leaks following endoscopic trans-sphenoidal surgery for pituitary disease

Abstract

Introduction. Our aim was to evaluate the routine use of a pedicled nasoseptal flap (NSF) as a primary repair for intra-operative CSF leaks compared with fat/fascia lata graft and lumbar drain insertion by performing a retrospective review of elective patients undergoing primary trans-sphenoidal surgery from January 2008 to present. Materials and methods. A retrospective review of consecutive primary elective trans-sphenoidal cases for sellar pathology was undertaken. Prior to September 2009, microscopic trans-sphenoidal surgery (MTSS) was performed in 40 cases and since then endoscopic trans-sphenoidal surgery (ETSS) was performed in 100 cases. Results and analysis. In the MTSS group, intra-operative CSF leaks were repaired with fat graft, tisseal and lumbar drain insertion. Intra-operative leaks in the ETSS group were routinely repaired with a pedicled NSF. Post-operative CSF leak rates were 12.5% in the MTSS and 3% in the ETSS groups, respectively. Three patients in the ETSS group developed a post-op CSF leak. All of these patients underwent surgery for craniopharyngiomas. This group had subsequent endoscopic repairs and were managed with repositioning of the NSF. Conclusion. The advent of the pedicled NSF conveys a significant advantage in preventing post-operative CSF leak, decreasing the morbidity associated with lumbar drain insertion and reduces the length of hospital stay.