2025 Poster Presentations
P041: CLINICAL ANALYSIS OF FIBRIN SEALANT FOR CEREBROSPINAL FLUID LEAKS IN TRANSNASAL TRANSSPHENOIDAL ENDOSCOPIC SURGERY: A SYSTEMATIC REVIEW OF LITERATURE
Amal Khiralla, MD1; Soneesh Kothagundla2; 1Mass Eye And Ear; 2Georgia Institute of Technology
KEYWORDS: Cerebrospinal Fluid Leak, Cranial Surgery, Fibrin Glue, Neurosurgery, Sealant
BACKGROUND/INTRODUCTION: Cerebrospinal Fluid (CSF) Leaks are a common complication intraoperatively and postoperatively in neurosurgery. With the evolution of endoscopic surgeries over the last few years, CSF leaks are still a common complication following this approach. Reconstruction of skull base defects following these procedures has been a challenge for this novel approach. Our study objective is to explore the outcomes of using Fibrin sealants to prevent and repair postoperative CSF leaks following endoscopic endonasal transsphenoidal approach (EETA) in patients with various skull base pathologies, and iatrogenic CSF leak. The incidence of CSF leak still remains a crucial outcome in determining the success of this approach. We will exclude repair of traumatic CSF leaks, and skull base bony defects resulting in spontaneous CSF leaks. The long term outcome of fibrin sealant use is scarce in literature and the aim is to review the literature for outcomes such as recurrence of CSF leaks, and need for revision surgery.
METHODS: An extensive systematic literature search was conducted using four significant databases: PubMed (n = 125), Embase (n = 317), and Web of Science (n = 106). Deduplication, title and abstract screening, and full-text screening was performed through rayyan.ai. Randomized control trials and case reports that included cerebrospinal fluid leakage and methods such as fibrin glue to prevent or repair the leak following EETA were included. ROBINS-I tool was used for quality assessment of the research found. Subsequently, data extraction was done through Microsoft Excel and statistical analyses and figure generation was done through STATA Basic Edition (StataCorp).
RESULTS: Fibrin was commonly used along with grafts or layers of fat such as fascia lata or pedicled nasoseptal flap (PNSF). Fibrin Sealant was used for reconstruction in an endoscopic transsphenoidal surgery reconstruction and none of the patients had negative postoperative outcomes related to the fibrin sealant. Following this, we conducted an analysis that shows the correlation between fibrin sealant, surgical approaches, pathology location, and time and presentation of CSF leak.
CONCLUSION: A lot of the studies included CSF leakage as a complication postoperatively and intraoperatively with many types of endoscopic surgeries. However, the heterogeneity in the data such as how fibrin sealant was used in combination with other types of methods to prevent recurrence of CSF leak like grafts is significant. But overall, fibrin sealant correlates to a fine choice in aiding the prevention and repair of CSF leakage in neurosurgery.