Less invasive skull base reconstruction using gelatin sponge and collagen matrix to prevent cerebrospinal fluid leakage after endoscopic transsphenoidal surgery: experience in 558 cases.

purposeWe evaluated the effectiveness of a less invasive skull base reconstruction technique using a fibrin glue-soaked gelatin sponge (FGGS) and collagen matrix to prevent cerebrospinal fluid (CSF) leakage following endoscopic transsphenoidal surgery (ETSS). This approach minimizes the need for fascia harvesting and the use of nasoseptal flaps.

methodsWe retrospectively analyzed data from 558 ETSS, excluding Rathke's cleft cysts, performed at our institution. Surgeries were classified by intraoperative CSF leakage grade according to Esposito's classification. Patients' characteristics and intraoperative findings were analyzed to assess potential risk factors for postoperative CSF leakage. Postoperative CSF leakage rates were compared between the pre-collagen matrix (428 surgeries) and collagen matrix (130 surgeries) periods.

resultsFGGS-based reconstruction without fat grafts was performed in 73.7% of surgeries, including 99.4% of grade 0 and 88.5% of grade 1 leaks. Nasoseptal flaps were used in only eight surgeries (1.4%), and fascia was not used at all, either for watertight dural suturing or for multilayer reconstruction. The overall postoperative CSF leakage rate was 1.8% (10/558). The leakage rates by intraoperative CSF leak grade were 0%, 1.7%, 5.6%, and 1.1% for grades 0, 1, 2, and 3, respectively. Postoperative CSF leakage was associated with unfamiliar techniques and excessive bucking during extubation. During the collagen matrix period, although 33.8% of surgeries involved grade 3 high-flow CSF leaks, only one surgery (0.8%; 1/130) resulted in postoperative CSF leakage.

conclusionsAs a less invasive technique, skull base reconstruction using FGGS and/or a collagen matrix was effective in reducing postoperative CSF leakage.