Prevention of Cerebrospinal Fluid Rhinorrhea After Transsphenoidal Surgery by Collagen Fleece Coated With Fibrin Sealant Without Autologous Tissue Graft or Postoperative Lumbar Drainage

Cho, Jin Mo; Ahn, Jung Yong; Chang, Jong Hee; Kim, Sun Ho

doi:10.1227/neu.0b013e318207b4ea

Cited by 22 publications

(32 citation statements)

References 25 publications

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“…We have kept the policy that tumors adhering severely to the ICA or pituitary gland were not removed and the blind curettage was not used in order to avoid dangerous conditions. No special reconstruction technique of skull base defect was required in of any patients without intraoperative cerebrospinal fluid (CSF) leakage, however, we combined various techniques such as multi-layers of collagen fleece coated with fibrin sealant, on-lay graft of injectable hydroxyapatite cement, fascia graft, and pedicled nasoseptal flap to achieve multi-layer reconstruction when intraoperative CSF leakage was occurred8,9,19,22,26).…”

Section: Methodsmentioning

confidence: 99%

Feasibility of Endoscopic Endonasal Approach for Recurrent Pituitary Adenomas after Microscopic Trans-Sphenoidal Approach

Hwang

Kim

et al. 2013

J Korean Neurosurg Soc

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ObjectiveThe surgical approach for recurrent pituitary adenoma after trans-sphenoidal approach (TSA) is challenging. We report the outcomes of the endoscopic TSA for recurrent pituitary adenoma after microscopic TSA.MethodsFrom February 2010 to February 2013, endoscopic TSA was performed for removal of 30 recurrent pituitary adenomas after microscopic TSA. Twenty-seven (90%) patients had a clinically non-functioning pituitary adenoma. Twenty-four (80%) patients suffered from a visual disturbance related to tumor growth. The clinical features and surgical outcomes were retrospectively analyzed for the ophthalmological, endocrinological, and oncological aspects.ResultsThe mean tumor volume was 11.7 cm3, and gross total resection was achieved in 50% of patients. The volumetric analysis based on the postoperative MR showed that the mean extent of resection rates were 90%. Vision was improved in 19 (79%) of 24 patients with visual symptoms, and endocrinological cure was achieved in all of three functioning pituitary adenomas; however, the post-operative follow-up endocrinological examination revealed a new endocrinological deficit in one patient. Two patients required antibiotics management for post-operative meningitis.ConclusionThe endoscopic TSA can be an effective treatment option for recurrent pituitary adenoma after microscopic TSA with acceptable outcome.

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Section: Methodsmentioning

confidence: 99%

Feasibility of Endoscopic Endonasal Approach for Recurrent Pituitary Adenomas after Microscopic Trans-Sphenoidal Approach

Hwang

Kim

et al. 2013

J Korean Neurosurg Soc

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“…In our early experience, we used conventional sellar floor repair methods using autologous tissue grafts such as fat, muscle, or tensor fascia lata with or without postoperative lumbar drainage of CSF. However, since 2005, we tried to repair the primary leaking point directly with various techniques according to the type of intraoperative leakage: collagen fleece coated with a fibrin sealant (TachoComb; Nycomed Austria, Linz, Austria) [13]; an arachnoid membrane coaptation technique [13]; direct suture of the torn arachnoid membrane; and a fascia repair technique. Although the removal of a pseudocapsule increases the risk of intraoperative CSF leakage, we now believe it can be managed by proper closure techniques without the aid of postoperative lumbar CSF drainage.…”

Section: Biochemical Remission In Endocrine-active Tumorsmentioning

confidence: 99%

Extracapsular en bloc resection in pituitary adenoma surgery

Kim

Lee

et al. 2014

Pituitary

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“…The rate of the postoperative CSF rhinorrhea needing second reconstruction in our 255 consecutive cases of transsphenoidal surgery (1.6%) appears lower than those of the preceding reports, 1.5-10%, [5][6][7]9,10,14,17) and suggests the usefulness of FGGS with diluted thrombin solution in neurosurgical practice. However, the rate may be influenced by the radicality of the surgery for suprasellar lesions.…”

Section: Discussionmentioning

confidence: 66%

Effect of Thrombin Concentration on the Adhesion Strength and Clinical Application of Fibrin Glue-Soaked Sponge

Campos

Shimizu

Sugata

et al. 2013

Neurol. Med. Chir.(Tokyo)

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Fibrin glue-soaked gelatin sponge (FGGS) has been used for tissue sealing in neurosurgical practice, but too rapid clotting of fibrin glue occasionally prevents good fixation of FGGS. Dilution of thrombin may provide adequate manipulation time between mixing fibrinogen and thrombin on gelatin sponge and application into the tissue defects. The present study characterized the effect of thrombin dilution on the adhesion strength of FGGS and retrospectively assessed the clinical usage of the dilution for filling dead space or sealing arachnoid defect in 255 cases who underwent transsphenoidal surgery for the last 66 months. FGGS was prepared using three different concentrations of thrombin: 250 (standard), 50 (1:5 dilution), and 25 (1:10 dilution) units/ml, and incubated for three different periods (5, 20, and 60 seconds). FGGSs were applied over two adjacently positioned porcine skins placed on two metallic plates. The adhesion strength was evaluated by measuring maximum tensile strength during pulling out the sliding plate at a constant rate of displacement. The maximum adhesion strength was greater for FGGS with 1:10 diluted thrombin solution than for FGGS prepared with higher concentrations (p º 0.05). Adhesion strength did not decay for 20 seconds after the mixture. Only four of 255 cases (1.6%) required second reconstruction of sella floor due to the cerebrospinal fluid leakage. FGGS prepared with diluted thrombin solution can provide adequate adhesion strength for clinical use.

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Prevention of Cerebrospinal Fluid Rhinorrhea After Transsphenoidal Surgery by Collagen Fleece Coated With Fibrin Sealant Without Autologous Tissue Graft or Postoperative Lumbar Drainage

Cited by 22 publications

References 25 publications

Feasibility of Endoscopic Endonasal Approach for Recurrent Pituitary Adenomas after Microscopic Trans-Sphenoidal Approach

Feasibility of Endoscopic Endonasal Approach for Recurrent Pituitary Adenomas after Microscopic Trans-Sphenoidal Approach

Extracapsular en bloc resection in pituitary adenoma surgery

Effect of Thrombin Concentration on the Adhesion Strength and Clinical Application of Fibrin Glue-Soaked Sponge

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