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Cerebrospinal fluid leakage repair of various grades developing during endoscopic transnasal transsphenoidal surgery
OBJECTIVES: We describe the strategy used to repair intraoperative leaks of various grades and define factors for preventing postoperative cerebrospinal fluid leakage (CSF) after surgery via the endoscopic endonasal transsphenoidal approach (EETA). STUDY DESIGN: Retrospective chart review at a terti...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997021/ https://www.ncbi.nlm.nih.gov/pubmed/33770089 http://dx.doi.org/10.1371/journal.pone.0248229 |
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author | Lee, Il Hwan Kim, Do Hyun Park, Jae-Sung Jeun, Sin-Soo Hong, Yong-Kil Kim, Sung Won |
author_facet | Lee, Il Hwan Kim, Do Hyun Park, Jae-Sung Jeun, Sin-Soo Hong, Yong-Kil Kim, Sung Won |
author_sort | Lee, Il Hwan |
collection | PubMed |
description | OBJECTIVES: We describe the strategy used to repair intraoperative leaks of various grades and define factors for preventing postoperative cerebrospinal fluid leakage (CSF) after surgery via the endoscopic endonasal transsphenoidal approach (EETA). STUDY DESIGN: Retrospective chart review at a tertiary referral center. METHODS: Patients who underwent surgery via EETA from January 2009 to May 2020 were retrospectively reviewed. Intraoperative CSF leakage was graded 0–3 in terms of the dural defect size; various repairs were used depending on the grade. RESULTS: A total of 777 patients underwent 869 operations via EETA; 609 (70.1%) experienced no intraoperative CSF leakage (grade 0) but 260 (29.9%) did. Leakage was of grade 1 in 135 cases (15.5%), grade 2 in 83 (9.6%), and grade 3 in 42 (4.8%). In 260 patients with intraoperative CSF leakage, a buttress was wedged into the sellar defect site in 178 cases (68.5%) and a pedicled flap was placed in 105 cases (40.4%). Autologous fat (108 cases, 41.5%) and a synthetic dural substitute (91 cases, 35%) were used to fill the dead space of the sellar resection cavity. Postoperative CSF leakage developed in 21 patients: 6 of grade 1, 7 of grade 2, and 8 of grade 3. Buttress placement significantly decreased postoperative leakage in grade 1 patients (p = 0.041). In patients of perioperative leakage grades 2 and 3, postoperative CSF leakage was significantly reduced only when both fat and a buttress were applied (p = 0.042 and p = 0.043, respectively). CONCLUSION: A buttress prevented postoperative CSF leakage in grade 1 patients; both fat and buttress were required by patients with intraoperative leakage of grades 2 and 3. |
format | Online Article Text |
id | pubmed-7997021 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-79970212021-04-06 Cerebrospinal fluid leakage repair of various grades developing during endoscopic transnasal transsphenoidal surgery Lee, Il Hwan Kim, Do Hyun Park, Jae-Sung Jeun, Sin-Soo Hong, Yong-Kil Kim, Sung Won PLoS One Research Article OBJECTIVES: We describe the strategy used to repair intraoperative leaks of various grades and define factors for preventing postoperative cerebrospinal fluid leakage (CSF) after surgery via the endoscopic endonasal transsphenoidal approach (EETA). STUDY DESIGN: Retrospective chart review at a tertiary referral center. METHODS: Patients who underwent surgery via EETA from January 2009 to May 2020 were retrospectively reviewed. Intraoperative CSF leakage was graded 0–3 in terms of the dural defect size; various repairs were used depending on the grade. RESULTS: A total of 777 patients underwent 869 operations via EETA; 609 (70.1%) experienced no intraoperative CSF leakage (grade 0) but 260 (29.9%) did. Leakage was of grade 1 in 135 cases (15.5%), grade 2 in 83 (9.6%), and grade 3 in 42 (4.8%). In 260 patients with intraoperative CSF leakage, a buttress was wedged into the sellar defect site in 178 cases (68.5%) and a pedicled flap was placed in 105 cases (40.4%). Autologous fat (108 cases, 41.5%) and a synthetic dural substitute (91 cases, 35%) were used to fill the dead space of the sellar resection cavity. Postoperative CSF leakage developed in 21 patients: 6 of grade 1, 7 of grade 2, and 8 of grade 3. Buttress placement significantly decreased postoperative leakage in grade 1 patients (p = 0.041). In patients of perioperative leakage grades 2 and 3, postoperative CSF leakage was significantly reduced only when both fat and a buttress were applied (p = 0.042 and p = 0.043, respectively). CONCLUSION: A buttress prevented postoperative CSF leakage in grade 1 patients; both fat and buttress were required by patients with intraoperative leakage of grades 2 and 3. Public Library of Science 2021-03-26 /pmc/articles/PMC7997021/ /pubmed/33770089 http://dx.doi.org/10.1371/journal.pone.0248229 Text en © 2021 Lee et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Lee, Il Hwan Kim, Do Hyun Park, Jae-Sung Jeun, Sin-Soo Hong, Yong-Kil Kim, Sung Won Cerebrospinal fluid leakage repair of various grades developing during endoscopic transnasal transsphenoidal surgery |
title | Cerebrospinal fluid leakage repair of various grades developing during endoscopic transnasal transsphenoidal surgery |
title_full | Cerebrospinal fluid leakage repair of various grades developing during endoscopic transnasal transsphenoidal surgery |
title_fullStr | Cerebrospinal fluid leakage repair of various grades developing during endoscopic transnasal transsphenoidal surgery |
title_full_unstemmed | Cerebrospinal fluid leakage repair of various grades developing during endoscopic transnasal transsphenoidal surgery |
title_short | Cerebrospinal fluid leakage repair of various grades developing during endoscopic transnasal transsphenoidal surgery |
title_sort | cerebrospinal fluid leakage repair of various grades developing during endoscopic transnasal transsphenoidal surgery |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997021/ https://www.ncbi.nlm.nih.gov/pubmed/33770089 http://dx.doi.org/10.1371/journal.pone.0248229 |
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