Document Detail


Sellar floor reconstruction after transsphenoidal surgery using fibrin glue without grafting or implants: technical note.
MedLine Citation:
PMID:  16793438     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Different techniques have already been described for reconstructing the sellar floor after transsphenoidal (TS) procedures. This paper reports on the use of fibrin glue alone without grafting or the use of implants in the reconstruction of the sellar floor after TS. METHODS: Five hundred sixty-seven patients who submitted to TS for pituitary and sellar region tumors were studied. No intraoperative cerebrospinal fluid (CSF) leak occurred in 503 patients (group 1); in the remaining 64 patients (group 2), intraoperative CSF leak was noted. In group 1 patients, closure of the sellar floor consisted of packing the surgical bed with hemostatic material only. When CSF leak was noted, the surgical bed was covered with a layer of hemostatic material and the intrasellar space was filled up with fibrin glue. An additional layer of hemostatic material was added at the topography of the preexisting sellar floor, and a second amount of fibrin glue was applied over it. At the end of surgery, a continuous lumbar CSF drainage system was installed in group 2 patients and kept for 5 days. Prophylactic antibiotics were administered during this period. RESULTS: We did not observe delayed CSF leak, meningitis, or visual loss in group 1 patients. In group 2, 2 patients presented with complications: 1 patient got meningitis but no overt CSF leak, and the other disclosed a delayed postoperative leak treated by reoperation. DISCUSSION: Our results showed that closure of the sellar floor with hemostatic material and fibrin glue without grafting or the use of implants is a safe and efficient method to prevent postoperative complications after TS. Generally speaking, there is no need for grafting or the use of implants at the end of TS.
Authors:
Lauro Seda; Rodio Brandao Camara; Arthur Cukiert; Jose Augusto Burattini; Pedro Paulo Mariani
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Surgical neurology     Volume:  66     ISSN:  0090-3019     ISO Abbreviation:  Surg Neurol     Publication Date:  2006 Jul 
Date Detail:
Created Date:  2006-06-23     Completed Date:  2006-08-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0367070     Medline TA:  Surg Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  46-9; discussion 49     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Hospital Brigadeiro, Sao Paulo-SP CEP 04544-000, Brazil.
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MeSH Terms
Descriptor/Qualifier:
Cerebrospinal Fluid Rhinorrhea / etiology,  physiopathology,  prevention & control
Cerebrospinal Fluid Shunts / standards,  statistics & numerical data
Fibrin Tissue Adhesive / therapeutic use*
Follow-Up Studies
Humans
Meningitis, Bacterial / drug therapy,  etiology,  prevention & control
Neurosurgical Procedures / instrumentation,  methods*
Pituitary Gland / anatomy & histology,  pathology,  surgery
Pituitary Neoplasms / diagnosis,  surgery*
Postoperative Complications / etiology,  physiopathology,  prevention & control
Prostheses and Implants / statistics & numerical data
Reconstructive Surgical Procedures / instrumentation,  methods*
Reoperation / statistics & numerical data
Sella Turcica / anatomy & histology,  pathology,  surgery*
Sphenoid Bone / anatomy & histology,  pathology,  surgery*
Transplants / statistics & numerical data
Treatment Outcome
Chemical
Reg. No./Substance:
0/Fibrin Tissue Adhesive

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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