• Hiroshi Nishioka, Hitoshi Izawa, Yukio Ikeda, Hiroaki Namatame, Shinjiro Fukami, and Jo Haraoka.
• Department of Neurosurgery, Hachioji Medical Center, Tokyo Medical University, Hachioji, Tokyo 193-0998, Japan. nishioka@tokyo-med.ac.jp
• Acta Neurochir (Wien). 2009 Nov 1;151(11):1427-30.

ObjectiveRepair of a cerebrospinal fluid (CSF) leak after transsphenoidal surgery (TSS) is usually accomplished using various graft materials. These methods are effective in most, but not all, cases.MethodsSince 2006, we have been directly suturing the sellar floor dura in patients with an intraoperative CSF leak. Fat and/or fascial grafts were utilized only when a major CSF leak developed. The incidence of postoperative CSF rhinorrhea was compared before and after the suture.ResultsPostoperative CSF rhinorrhea developed in 3.7% (7 out of 188) of cases before 2005, but never since the dural suture was introduced (0 out of 136, 0%; P = 0.0229). Although watertight closure was not achieved in some cases, narrowing the dural defect and supporting the intrasellar graft was attained in every case. Surgical time was approximately 30 min longer in patients who underwent dural suture (148 +/- 42 min) than those who did not (119 +/- 37 min; P = 0.0001).ConclusionDirect suturing of the sellar dura is a simple, safe, and reliable surgical technique for repairing CSF leaks after TSS. Using this procedure, more than 70% of patients with an intraoperative CSF leak can avoid autologous tissue grafts.

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