Abstract
Objectives:
Fat autograft has long been a reliable method for preventing cerebrospinal fluid (CSF) leak after transsphenoidal surgery. Our practice has transitioned from using fat autograft to using acellular dermal matrix (AlloDerm, LifeCell Corp, Woodlands, TX). The authors adopted an in-lay technique with one or two layers of AlloDerm wedged in place by an absorbable gelatin sponge (Gelfoam, Pharmacia and Upjohn. Kalamazoo, MI). Use of this material has been described as successful in smaller group series; however, we present the largest historical cohort of AlloDerm for sellar floor repair after transsphenoidal approach to pituitary adenoma.
Design:
This is a retrospective cohort study of transsphenoidal surgery for pituitary adenoma between the years 2003 and 2012, a time during which our surgeons transitioned from using fat graft to AlloDerm. The primary endpoint was postoperative CSF leak. Patients with intraoperative lumbar drain placement were excluded.
Results:
A total of 429 patients (368 primary; 83 revision operations) were included. A total of 18 postoperative CSF leaks were observed (4%). Sublabial (n = 187), endoscopic-assisted (n = 68), and pure endoscopic (n =196) approaches were used. In the 271 cases without intraoperative CSF leak, the sellar floor was closed with AlloDerm (60), fat graft (16), other materials (19), or no repair (176), resulting in 1, 0, 1, and 0 postoperative leaks, respectively (1.7%, 0%, 0.5%, and 0%). Intraoperative CSF leak occurred in 160 cases (35%). Repair methods after intraoperative leak and postoperative leak rates were: AlloDerm (n = 95; 8.4%); fat (n = 46; 15.2%); fascia lata, nasoseptal flap, other or no repair (n = 19; 0%). There was no statistically significant difference in postoperative CSF leak rates between AlloDerm and fat graft (
P
= 0.34, chi-square test).
Conclusions:
AlloDerm is an effective alternative to fat autograft for sellar floor repair; however, the application of more advanced techniques or materials might be warranted in patients at elevated risk for CSF rhinorrhea.