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Sandwich technique using fibrin-coated collagen fleece for sellar reconstruction in large dural defects during transsphenoidal surgery

 Jaeyoung So  ;  Hunho Park  ;  Kyeong-Soo Sung  ;  Kyu Sung Lee  ;  Chang-Ki Hong 
 Journal of Clinical Neuroscience, Vol.43 : 256-260, 2017 
Journal Title
 Journal of Clinical Neuroscience 
Issue Date
Adult ; Cerebrospinal Fluid Leak/etiology* ; Collagen* ; Drug Combinations ; Dura Mater/pathology ; Dura Mater/surgery* ; Female ; Fibrin* ; Fibrinogen* ; Humans ; Intraoperative Complications/etiology* ; Male ; Middle Aged ; Neurosurgical Procedures/adverse effects ; Neurosurgical Procedures/methods* ; Pituitary Neoplasms/surgery* ; Postoperative Complications/etiology* ; Reconstructive Surgical Procedures/adverse effects ; Reconstructive Surgical Procedures/methods* ; Sella Turcica/surgery* ; Sphenoid Sinus/surgery* ; Thrombin*
Cerebrospinal fluid leakage ; Complications ; Fibrin-coated collagen fleece ; Sandwich technique ; Transsphenoidal approach
PURPOSE: Various surgical methods to prevent intraoperative and postoperative cerebrospinal fluid (CSF) leaks during transsphenoidal approach (TSA) surgeries have been reported, but surgical techniques to address large dural defects have been less thoroughly investigated in the literature. The authors retrospectively evaluated the usefulness of the sandwich technique using fibrin-coated collagen fleece (TachoSil) to prevent intraoperative CSF leakage from large dural defects in TSA surgery. METHODS: In total, 101 cases of intraoperative CSF leaks were observed among 465 patients who underwent TSA surgery at a single university hospital between 2002 and 2014. Among them, cases with Grade 3 intraoperative CSF leakages and large diaphragmatic/dural defects were reconstructed via the sandwich technique using TachoSil or via the conventional technique using simple intrasellar packing with fat or synthetic materials, and these cases were enrolled in this study. RESULTS: A total of 28 cases with Grade 3 intraoperative CSF leakages were identified and analyzed. The sandwich technique using TachoSil was applied in 13 cases, and the conventional technique was applied in 15 cases. The postoperative CSF leakage was significantly decreased by the sandwich technique as compared to the conventional technique (retrospectively, 0 cases vs. 4 cases (30.8%); P=0.044). CONCLUSION: The sandwich technique using TachoSil can effectively prevent CSF leakage in cases with large dural defects during TSA surgery.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Park, Hun Ho(박현호) ORCID logo https://orcid.org/0000-0002-2526-9693
So, Jaeyoung(소재영)
Lee, Kyu Sung(이규성)
Hong, Chang Ki(홍창기)
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