Endoscopic transsphenoidal surgery reconstruction using the fibrin sealant patch Tachosil^®

Area of Science:

• Neurosurgery
• Skull Base Surgery
• Wound Healing

Background:

• Cerebrospinal fluid (CSF) leaks are a significant complication of endoscopic transsphenoidal surgery.
• The nasoseptal flap (NSF) is a common method for repairing these defects but carries risks like bleeding and altered smell.
• Tachosil®, an absorbable fibrin sealant patch, promotes hemostasis and healing.

Purpose of the Study:

• To evaluate the efficacy of Tachosil® in repairing intraoperative defects during endoscopic transsphenoidal surgery.
• To assess Tachosil® as an alternative or adjunct to the NSF for CSF leak repair.

Main Methods:

• Retrospective analysis of 52 primary procedures using Tachosil® for defect repair.
• Tachosil® was applied as an overlay patch in a multi-layered repair.
• Primary outcome was the rate of post-operative CSF leak.

Main Results:

• 23 (44.2%) intraoperative CSF leaks were identified.
• The overall post-operative CSF leak rate was 7.8% (4 patients).
• No adverse outcomes were attributed to Tachosil®.

Conclusions:

• Tachosil® can be safely used in a multi-layered approach for endoscopic skull base reconstruction.
• It serves as an effective alternative to NSF for low-flow CSF leaks.
• It can be used alongside NSF for higher-flow CSF leaks, with no reported post-operative leaks in combined cases.