CLOSURE OF INTRAOPERATIVE LOW-FLOW CSF LEAKS USING FIBRIN GLUE ALONE AND NO LUMBAR DRAINAGE DURING TRANSESPHENOIDAL SURGERY
Liberman B; Nogueira KC; Huayllas MC; Goldman J; Cukiert A; Burattini JA.
Departments of Endocrinology and Neurosurgery, Hospital Brigadeiro, Sao Paulo SP, Brazil
The closure of CSF leaks during transesphenoidal surgery might represent a challenge. Persistent CSF leak might lead to meningitis and often needs reoperation. We recently published on the use of fibrin glue alone (without any grafting) and lumbar drainage as a technique for closing these leaks. In this paper, we present the results of closing low-flow CSF leaks with fibrin glue alone without lumbar drainage or any type of grafting.
Thirty consecutive patients submitted to transesphenoidal surgery in whom an intraoperative low-flow CSF leak was noted were studied. We considered a “low-flow” intraoperative leak those leaks which were visually sealed after the application of haemostatic material (surgical) and fibrin glue. A two-layer seal including haemostatic material/fibrin glue was used in all patients. No graft or lumbar drainage was used. Patient were ask to remain in bed for 2 days.
No postoperative CSF leak was noted in these patients. There was no meningitis and no need for reoperation in this series.
No grafting or lumbar drainage is needed for the treatment of low-flow intraoperative CSF leaks occurring during transesphenoidal surgery. Lumbar drainage might be needed in high-flow intraoperative CSF leaks.