Endoscopic repair of large dural defects in transsphenoidal surgery by suturing acellular dermal matrix graft with the dura: a technical note.

Abstract

To introduce acellular dermal matrix (ADM) suturing as a novel repair method for intraoperative high-flow cerebrospinal fluid (CSF) leakage during transsphenoidal surgery (TSA), aiming to replace autologous fat/fascia lata grafts and reduce surgical morbidity. Five patients (2 invasive pituitary adenomas, 2 craniopharyngiomas, 1 epidermoid cyst) underwent total sellar/suprasellar tumor resection and presented intraoperative high-flow CSF leakage. ADM grafts were tailored to dural defects and sutured directly to native dural edges. Outcomes included repair integrity, operative efficiency, and postoperative complications (CSF leakage, infection). All cases achieved dural closure without autologous tissue harvesting. Mean operative time was reduced by avoiding graft harvest procedures. No postoperative CSF leakage or intracranial infections occurred. At 30-day follow-up, all patients exhibited satisfactory recovery with stable skull base reconstruction. ADM suture repair eliminates donor-site morbidity and shortens operative time while providing robust dural sealing. This technique may be a promising alternative to conventional autologous grafts for high-flow CSF leakage management, warranting larger-scale validation.