A new technique for dural suturing with fascia graft for cerebrospinal fluid leakage in transsphenoidal surgery.

Abstract

One of the most common postoperative complications of surgery using a transsphenoidal approach is cerebrospinal fluid (CSF) leakage, which typically results from inadequate repair of a CSF fistula created at the time of the initial operation. Most techniques use autologous tissue grafts of fat, muscle, or fascia lata, with or without the use of postoperative lumbar CSF drainage; however, patients demonstrate a relatively high incidence of CSF rhinorrhea, especially after extended procedures. We have developed a new technique of dural suturing with fascia graft using special suture-tying microinstruments. Twenty-one consecutive patients with suprasellar tumors underwent dural suturing with fascia graft via new suture-tying microinstruments between January 2004 and December 2007. The 21 patients were retrospectively divided into 2 groups according to the transsphenoidal technique used. Group 1 consisted of 16 patients whose large dural defects were closed with a fascia graft suture for CSF leakage during or after an extended transsphenoidal approach. Group 2 consisted of 5 patients whose dural defects were closed with a fascia graft suture for postoperative CSF rhinorrhea after a conventional transsphenoidal approach. None of the 21 patients developed any clinical symptoms of CSF leakage. There were no complications or infections. For 8 patients in group 1 and the 5 patients in Group 2, no postoperative lumbar drainage was performed after dural suturing with fascia graft, and none of the 13 patients developed postoperative CSF rhinorrhea. Our dural suturing technique with fascia graft may be more reliable than the conventional packing technique in achieving watertight dural closure and for the prevention of postoperative CSF rhinorrhea. Watertight dural suturing with fascia graft and the leaking point suture could allow surgeons to avoid unnecessary postoperative lumbar drainage.