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Article Type

Original Study

Subject Area

Skull base surgery

Abstract

Background Endoscopic endonasal transsphenoidal surgery is the gold standard method for surgical management of pituitary adenomas; yet the troublesome issue is the potential of cerebrospinal fluid (CSF) leak with possible persistent leak and meningitis. Sellar reconstruction is a prerequisite to prevent postoperative CSF leak. Watertight dural stitching is a reliable method of closure of intraoperative defects, but this was always challenging due to the narrow and deep operative field and the need of special designs of surgical instruments. We present a simple, easy to use direct dural suture with no need to additional surgical instrument for closure of dural tear after endoscopic endonasal pituitary surgery. Patients and methods This technique was applied to 15 patients who underwent endoscopic endonasal hypophysectomy with inadvertent intraoperative arachnoid injury. Sutures were 6/0 PDS suture from a 13 mm 3/8 needle. Suture application of sutures was done using a straight Blakesly forceps and spinal needle. Postoperative observation for CSF leak was conducted for 2 months. Results Watertight suture was reported in 12 cases. Failure to do suturing and shifting to other methods of reconstruction was done in two cases. One case showed early CSF leak and the leak stopped conservatively after few days. No other case showed CSF leak. Conclusion This suture technique is a simple and efficient for the prevention of posttransnasal hypophysectomy CSF leak.

Keywords

cerebrospinal fluid leak, dura, pituitary surgery, suture

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