2025 Poster Presentations
P283: VARIOUS SELLAR RECONSTRUCTION TECHNIQUES IN CASES WITH GRADE 1 & 2 CSF LEAKAGE DURING ETSA.
Hyukjin Oh1; Kyung Hwan Kim2; 1Soonchunhyang University Cheonan Hospital, Korea; 2Chungnam National University Hospital, Korea
Objective: ETSA has established itself as a representative surgical method for operating pituitary tumors. Intraoperative CSF leakage is a concern for all surgeons performing ETSA. Various sellar floor reconstruction techniques have been introduced, and each surgeon performs them slightly differently. This study reviews each reconstruction technique performed in ETSA cases, excluding the high-flow CSF leakage cases, and discusses the pros and cons.
Methods: From May 2017 to December 2023, 100 ETSA were performed. Emphasizing cases with low to moderate intraoperative Cerebrospinal Fluid (CSF) leakage, it evaluates the efficacy of various reconstruction methods in reducing postoperative complications and the need for revision surgery. A specific focus is placed on combining sphenoid sinus mucosa reconstruction with a fat graft (with or without dura suture), highlighting its role in minimizing reoperation rates.
Results: Out of the 100 ETSA cases analyzed, intraoperative CSF leakage (Grade 1 & 2) was confirmed in 38 cases (38%). Notably, patients who underwent reconstruction using the sphenoid sinus mucosa and fat graft method (with or without dura suture) demonstrated a significantly lower incidence of requiring revision surgery(2%). Only two patients required reoperation, indicating the effectiveness of this combined approach.
Conclusion: The study concludes that customized sellar floor reconstruction techniques, particularly the combination of sphenoid sinus mucosa reconstruction and fat grafting, can substantially decrease the risk of postoperative complications in ETSA. These findings advocate for adopting such techniques in routine clinical practice to enhance surgical outcomes and patient safety in the management of pituitary tumors. Further research is recommended to refine these methods and assess their effectiveness in high-flow CSF leakage cases.