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Updated: Jun 6, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Management of intra-operative cerebrospinal fluid leak following endoscopic trans-sphenoidal pituitary surgery
C G L Hobbs1, A Darr, W V Carlin
1Department of Otolaryngology-Head and Neck Surgery, Western Health, Melbourne, Victoria, Australia. chris.hobbs@doctors.org.uk
Objective:
Cerebrospinal fluid leakage is the most common complication of endoscopic trans-sphenoidal pituitary surgery. However, there is no uniformly accepted way of managing this complication when it occurs intra-operatively. This paper describes a quick, simple technique, involving layered fibrin glue and gelatin sponge, which does not compromise post-operative patient follow up.
Method:
Retrospective review of all endoscopic pituitary surgery cases conducted at a single institution since the introduction of this technique in 2002.
Results:
A total of 120 endoscopic pituitary operations were performed (96 primary procedures and 24 revisions). All intra-operative cerebrospinal fluid leaks were managed using the described method, with a failure rate of 3.6 per cent. The overall post-operative leakage rate was 1.7 per cent.
Conclusion:
This simple, conservative technique avoids the need for further dissection and the use of non-absorbable foreign material, and has a low incidence of post-operative cerebrospinal fluid leakage.
