Abstract：
BACKGROUND: During pituitary surgery, CSF leaks are often treated by intrasellar packing, using muscle or fat grafts. However, this strategy may interfere with the interpretation of postoperative MRI and may impact the quality of resection in cases of second surgery, due to the existence of additional fibrous tissue. We present an alternative technique, using a diaphragm reconstruction with a heterologous sponge combining fibrinogen and thrombin (TachoSil), applied in selected patients with low-flow CSF leaks. This study investigates the surgical outcome of patients treated with this strategy.
METHODS: From a cohort of 2231 patients treated from June 2011 to June 2023 by endoscopic endonasal approach for pituitary surgery, the surgical technique of diaphragm repair with TachoSil patch performed in 55 patients (2.6%) was detailed, and the rate of closure failure was analyzed at 6 months postoperatively. No intrasellar packing was used and sellar floor reconstruction was performed whenever possible. The rate of postoperative CSF leak was compared with that reported in three previous publications that also used the TachoSil patch technique.
RESULTS: Patients were mostly women (F/M ratio: 1.2) with a median age of 53.6 years. Surgery was indicated for non-functioning adenomas, Cushing\'s disease, acromegaly, and Rathke\'s cleft cysts in 38/55 (69.1%), 6/55 (10.9%), 5/55 (9.1%) and 6/55 (10.9%) patients respectively. The rate of postoperative CSF leak was 1.8% (n = 1/55), which was not significantly different from that reported in the three cohorts from the literature (2.8%, p > 0.05). No postoperative meningitis was recorded.
CONCLUSIONS: In highly selected patients with low-flow CSF leaks related to small focal diaphragm defects, diaphragm reconstruction using a TachoSil patch can be a safe and valuable alternative to intrasellar packing.
METHODS: From a cohort of 2231 patients treated from June 2011 to June 2023 by endoscopic endonasal approach for pituitary surgery, the surgical technique of diaphragm repair with TachoSil patch performed in 55 patients (2.6%) was detailed, and the rate of closure failure was analyzed at 6 months postoperatively. No intrasellar packing was used and sellar floor reconstruction was performed whenever possible. The rate of postoperative CSF leak was compared with that reported in three previous publications that also used the TachoSil patch technique.
RESULTS: Patients were mostly women (F/M ratio: 1.2) with a median age of 53.6 years. Surgery was indicated for non-functioning adenomas, Cushing\'s disease, acromegaly, and Rathke\'s cleft cysts in 38/55 (69.1%), 6/55 (10.9%), 5/55 (9.1%) and 6/55 (10.9%) patients respectively. The rate of postoperative CSF leak was 1.8% (n = 1/55), which was not significantly different from that reported in the three cohorts from the literature (2.8%, p > 0.05). No postoperative meningitis was recorded.
CONCLUSIONS: In highly selected patients with low-flow CSF leaks related to small focal diaphragm defects, diaphragm reconstruction using a TachoSil patch can be a safe and valuable alternative to intrasellar packing.
摘要：
背景：在垂体手术期间，脑脊液漏通常通过鞍内填塞治疗，使用肌肉或脂肪移植物。然而,这种策略可能会干扰术后MRI的解释，并可能影响二次手术的切除质量，由于存在额外的纤维组织。我们提出了一种替代技术，使用异源海绵结合纤维蛋白原和凝血酶（TachoSil）进行隔膜重建，适用于选定的低流量脑脊液渗漏患者。这项研究调查了采用这种策略治疗的患者的手术结果。
方法：从2011年6月至2023年6月通过内镜经鼻入路进行垂体手术的2231例患者队列中，详细介绍了55例患者（2.6％）使用TachoSil补片进行diaphragm肌修复的手术技术，术后6个月分析闭合失败率。不使用鞍内包装，并尽可能进行鞍底重建。将术后CSF泄漏的发生率与以前三篇也使用TachoSil贴片技术的出版物中报道的发生率进行了比较。
结果：患者大多为女性（F/M比：1.2），中位年龄为53.6岁。无功能腺瘤需要手术治疗，库欣病,肢端肥大症,和Rathke'sleft囊肿在38/55（69.1%），6/55（10.9%），5/55（9.1％）和6/55（10.9％）患者。术后脑脊液漏发生率为1.8%(n=1/55),这与文献中三个队列中报道的没有显着差异(2.8%，p>0.05)。没有记录到术后脑膜炎。
结论：在高度选择的与小的局灶性隔膜缺损相关的低流量CSF泄漏患者中，使用TachoSil补片进行膈肌重建可能是一种安全且有价值的替代方法。
方法：从2011年6月至2023年6月通过内镜经鼻入路进行垂体手术的2231例患者队列中，详细介绍了55例患者（2.6％）使用TachoSil补片进行diaphragm肌修复的手术技术，术后6个月分析闭合失败率。不使用鞍内包装，并尽可能进行鞍底重建。将术后CSF泄漏的发生率与以前三篇也使用TachoSil贴片技术的出版物中报道的发生率进行了比较。
结果：患者大多为女性（F/M比：1.2），中位年龄为53.6岁。无功能腺瘤需要手术治疗，库欣病,肢端肥大症,和Rathke'sleft囊肿在38/55（69.1%），6/55（10.9%），5/55（9.1％）和6/55（10.9％）患者。术后脑脊液漏发生率为1.8%(n=1/55),这与文献中三个队列中报道的没有显着差异(2.8%，p>0.05)。没有记录到术后脑膜炎。
结论：在高度选择的与小的局灶性隔膜缺损相关的低流量CSF泄漏患者中，使用TachoSil补片进行膈肌重建可能是一种安全且有价值的替代方法。
