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Sealing of cerebrospinal fluid leakage during conventional transsphenoidal surgery using a fibrin-coated collagen fleece

Authors
 Chang Ki Hong  ;  Yong Bae Kim  ;  Je Beom Hong  ;  Kyu Sung Lee 
Citation
 JOURNAL OF CLINICAL NEUROSCIENCE, Vol.22(4) : 696-699, 2015 
Journal Title
 JOURNAL OF CLINICAL NEUROSCIENCE 
ISSN
 0967-5868 
Issue Date
2015
MeSH
Adult ; Cerebrospinal Fluid Leak/therapy* ; Cerebrospinal Fluid Rhinorrhea/prevention & control ; Chordoma/surgery ; Collagen/therapeutic use* ; Cranial Fossa, Posterior/surgery ; Drug Combinations ; Female ; Fibrin Tissue Adhesive/therapeutic use* ; Fibrinogen/therapeutic use* ; Humans ; Intraoperative Complications/therapy* ; Length of Stay ; Male ; Meningitis/etiology ; Middle Aged ; Pituitary Neoplasms/surgery ; Postoperative Complications/prevention & control ; Retrospective Studies ; Sella Turcica/surgery ; Sphenoid Bone/surgery* ; Thrombin/therapeutic use* ; Tissue Adhesives/therapeutic use*
Keywords
Cerebrospinal fluid leakage ; Complications ; Fibrin-coated collagen fleece ; Lumbar drainage ; Transsphenoidal approach
Abstract
The prevention of cerebrospinal fluid (CSF) leakage is a key feature of the transsphenoidal approach (TSA) to the pituitary fossa. Although fibrin-coated collagen fleece (Tachosil, Nycomed, Linz, Austria) is a powerful topical hemostatic agent whose usage is increasing in open neurosurgery, the use of Tachosil in TSA surgery has not yet gained wide clinical acceptance. We retrospectively evaluated whether the lone use of Tachosil without additional packing material or postoperative lumbar drainage was effective to prevent CSF leakage in TSA surgery in 101 patients. Additionally, we compared it to a conventional sellar closure technique in 54 patients. Only two (1.9%) of the patients in the Tachosil application group developed postoperative CSF rhinorrhea. No other postoperative complications occurred, including infection or material detachment. However, in the conventional packing group, five (9.3%) patients developed postoperative CSF rhinorrhea and one (1.9%) developed meningitis during the postoperative period. The mean length of postoperative hospital stay was significantly shorter in the Tachosil treatment group than in the standard closure group. These results may indicate that sellar repair using Tachosil can be effective to prevent CSF leakage after TSA surgery, and obviate the need for an autologous tissue graft or postoperative lumbar drainage.
Full Text
http://www.sciencedirect.com/science/article/pii/S0967586814006705
DOI
10.1016/j.jocn.2014.10.019
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0003-2262-7157
Lee, Kyu Sung(이규성)
Hong, Chang Ki(홍창기)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/140487
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