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Direct suture technique of normal gland edge on the incised dura margin to repair the intraoperative cerebrospinal fluid leakage from the arachnoid recess during transsphenoidal pituitary tumor surgery

 Kim, Eui Hyun  ;  Roh, Tae Hoon  ;  Park, Hun Ho  ;  Moon, Ju Hyung  ;  Hong, Je Beom  ;  Kim, Sun Ho 
 NEUROSURGERY, Vol.11(1) : 26-31, 2015 
Journal Title
Issue Date
Adenoma/surgery* ; Adolescent ; Adult ; Aged ; Arachnoid/surgery ; Cerebrospinal Fluid Leak/diagnosis ; Cerebrospinal Fluid Leak/etiology ; Cerebrospinal Fluid Leak/surgery* ; Dura Mater/surgery* ; Female ; Fibrin Tissue Adhesive/therapeutic use ; Humans ; Intraoperative Complications* ; Male ; Middle Aged ; Pituitary Neoplasms/surgery* ; Suture Techniques* ; Sutures ; Tissue Adhesives/therapeutic use ; Young Adult
Arachnoid recess repair ; Cerebrospinal fluid leakage ; Pituitary adenoma ; Suture technique ; Transsphenoidal surgery
BACKGROUND: During transsphenoidal surgery for pituitary adenomas with large suprasellar extension, cerebrospinal fluid (CSF) leakage commonly develops from a defect at the arachnoid recess between the resected dura margin and the anterior edge of a normal pituitary gland (type 1 CSF leakage). OBJECTIVE: To evaluate the usefulness of a direct suture technique of the normal gland edge on the incised dural margin to repair intraoperative CSF leakage from the arachnoid recess. METHODS: Between November 2005 and December 2012, 861 patients with pituitary adenomas were operated on with transsphenoidal surgery, and intraoperative CSF leakage was encountered in 432 patients. Type 1 CSF leakage developed in a total of 122 patients, and their defects were repaired with the direct suture technique in 51 patients, whereas a fleece-coated fibrin glue patch alone was applied onto the defect in the other 71 patients. This direct suture technique required an additional 5 to 20 minutes in most cases. RESULTS: We experienced no case of postoperative CSF rhinorrhea in the 51 patients whose defects were repaired by the direct suture technique and only 1 case of CSF rhinorrhea in 71 patients whose defects were repaired with a fleece-coated fibrin glue patch alone. There was no statistical difference in the outcome between 2 groups. Postoperative lumbar CSF drainage was not performed in any case. CONCLUSION: Our 2 different repair techniques for arachnoid recess tears are very reliable methods for managing this type of CSF leakage. The direct suture technique may be more appropriate for type 1 CSF leakage with a wider gap and more prominent CSF leakage.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sun Ho(김선호) ORCID logo https://orcid.org/0000-0003-0970-3848
Kim, Eui Hyun(김의현) ORCID logo https://orcid.org/0000-0002-2523-7122
Roh, Tae Hoon(노태훈)
Moon, Ju Hyung(문주형)
Park, Hun Ho(박현호) ORCID logo https://orcid.org/0000-0002-2526-9693
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