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Prevention of cerebrospinal fluid rhinorrhea after transsphenoidal surgery by collagen fleece coated with fibrin sealant without autologous tissue graft or postoperative lumbar drainage

 Jin Mo Cho  ;  Jung Yong Ahn  ;  Jong Hee Chang  ;  Sun Ho Kim 
 NEUROSURGERY, Vol.68(1 Suppl Operative) : 130-137, 2011 
Journal Title
Issue Date
Adolescent ; Adult ; Aged ; Cerebrospinal Fluid Rhinorrhea/etiology ; Cerebrospinal Fluid Rhinorrhea/prevention & control* ; Collagen ; Female ; Fibrin Tissue Adhesive ; Humans ; Hypophysectomy/adverse effects ; Male ; Middle Aged ; Neurosurgery ; Pituitary Neoplasms/surgery ; Postoperative Complications/physiopathology* ; Retrospective Studies ; Sphenoid Bone/anatomy & histology ; Sphenoid Bone/surgery* ; Tissue Adhesives/administration & dosage* ; Young Adult
Cerebrospinal fluid rhinorrhea ; Collagen fleece coated with fibrin sealant ; Intraoperative cerebrospinal fluid leak ; Postoperative lumbar cerebrospinal fluid drainage ; Transsphenoidal surgery
BACKGROUND: Autologous tissue grafting and postoperative lumbar cerebrospinal fluid (CSF) drainage (PLD) have been used to prevent CSF rhinorrhea after transsphenoidal surgery. OBJECTIVE: To describe the technical details and efficacy of our techniques of using collagen fleece coated with fibrin sealant (TachoComb, Nycomed, Linz, Austria) instead of an autologous tissue graft and refraining from the use of PLD. METHODS: We retrospectively reviewed 307 consecutive patients who underwent a transsphenoidal surgery for pituitary adenoma from November 2005 to February 2008. Among them, 90 cases of intraoperative CSF leaks were repaired with TachoComb without an autologous tissue graft or PLD. The repair procedures were tailored according to CSF leakage type, and we used only Bioglue (Cryolife Inc, Atlanta, Georgia) for sellar floor reconstruction. RESULTS: The overall rate of CSF rhinorrhea was 2.2% (2 of 90 cases). The 2 cases of CSF rhinorrhea resulted from large arachnoid defects, and there were no adverse effects from TachoComb such as transmission of viral disease or infection. CONCLUSION: Our technique is an alternative method to the traditional autologous tissue graft technique. PLD is not an essential procedure for the prevention of CSF rhinorrhea if the intraoperative CSF leak is completely sealed off during the transsphenoidal surgery. However, in cases of large arachnoid defects, aggressive repair of the arachnoid defect and sellar floor reconstruction with bone or bony substitutes should be considered in conjunction with our methods.
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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
Ahn, Jung Yong(안정용)
Chang, Jong Hee(장종희)
Cho, Jin Mo(조진모)
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