Three types of dural suturing for closure of CSF leak after endoscopic transsphenoidal surgery

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OBJECTIVE

Transsphenoidal surgery (TSS) is commonly used for anterior skull base surgery, especially in the sella turcica (sellar) region. However, because of its anatomical position, CSF leakage is a major complication of this approach. The authors introduced a new grading reconstruction strategy for anterior skull base surgery with continuous dural suturing in 2013. In this paper the authors report on their methods and results.

METHODS

All patients with sellar or anterior skull base lesions that were removed with TSS or extended TSS by a single neurosurgeon between April 2013 and March 2017 at Nagoya University Hospital and several cooperating hospitals were retrospectively identified. Three methods of suturing dura were considered, depending on the dural defect.

RESULTS

There were 176 TSS cases (141 conventional TSS cases and 35 extended endoscopic TSS cases) and 76 cases of Esposito’s grade 2 or 3 intradural high-flow CSF leakage. In the high-flow CSF leak group, there were 3 cases of CSF leakage after the operation. The rates of CSF leakage after surgery corresponding to grades 2 and 3 were 2.9% (1/34) and 4.7% (2/42), respectively.

CONCLUSIONS

Dural suturing is a basic and key method for reconstruction of the skull base, and continuous suturing is the most effective approach. Using this approach, the frequency of cases requiring a nasoseptal flap and lumbar drainage can be reduced.

ABBREVIATIONS EETSS = extended endoscopic TSS; NFPA = nonfunctioning pituitary adenoma; QOL = quality of life; TSM = tuberculum sellae meningioma; TSS = transsphenoidal surgery.
Article Information

Contributor Notes

Correspondence Takayuki Ishikawa: Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan. ishikawa.takayuki@h.mbox.nagoya-u.ac.jp.INCLUDE WHEN CITING Published online November 2, 2018; DOI: 10.3171/2018.4.JNS18366.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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