Use of equine pericardium sheet (LYOMESH®) as dura mater substitute in endoscopic endonasal transsphenoidal surgery

OBJECTIVE: The aim of this study was to describe the use of equine pericardium sheet (Lyomesh ( ® ) ) as dural substitute for sellar reconstruction after endoscopic endonasal transsphenoidal surgery for the removal of pituitary adenomas. METHODS: We reviewed data of patients that underwent surgery by means of an endoscopic endonasal transsphenoidal approach for the removal of pituitary adenomas over a 12-months period, starting in May 2012, i.e. when we adopted Lyomesh ( ® ) (Audio Technologies, Piacenza, Italy) an equine pericardium sheet, as dura mater substitute. RESULTS: During the 12-months period evaluated, we performed an endoscopic endonasal transsphenoidal operation for a variety of pituitary lesions on 102 consecutive patients. Among these, in 12 patients (9.4%) harboring a pituitary adenoma, the implant of the pericardium sheet was used. Four patients (33.3%) presented a small intraoperative cerebrospinal fluid (CSF) leak; in these cases the Lyomesh ( ® ) was placed intradurally with fibrin glue and, thereafter, several layers were positioned in extradural space. In 8 other subjects without any evidence of CSF leak, the dural substitute was placed intradurally and fibrin glue was injected intradurally to hold the material in place. CONCLUSIONS: Even if based on a relatively small patient series, our experience demonstrated that the use of equine pericardium sheet (Lyomesh ( ® ) ) as dura mater substitute in transsphenoidal surgery is safe and biocompatible, as compared with other dural substitutes.