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

The incidence of CSF leak following endoscopic transsphenoidal surgery remains the most important measure in the success of any repair. The nasoseptal flap (NSF) has played a pivotal role in reconstructing defects. However, morbidity associated with the NSF includes bleeding, septal injury, altered smell and crusting. Tachosil^® is an absorbable fibrin sealant patch that promotes haemostasis and wound healing. The purpose of this study was to evaluate the effectiveness of Tachosil^® to repair intraoperative defects during an endoscopic transsphenoidal approach.

All patients who underwent an endoscopic transsphenoidal approach with the use of Tachosil^® at the Queen Elizabeth Hospital Birmingham, between January 2013 and June 2020 were retrospectively analysed. Tachosil^® was used as an overlay patch over of the bony defect, in a multi-layered repair depending on the defect and grade of CSF leak. The primary outcome measure was post-operative CSF leak.

A total of 52 primary procedures where Tachosil^® was used as the overlay were analysed. There were 23 (44.2%) intraoperative CSF leaks. The overall post-operative CSF leak rate was 7.8% (n = 4), with all cases having had a Tachosil^® overlay reconstruction with no NSF. A formal NSF was harvested in only five cases alongside the Tachosil^® patch, where a grade 2 or more leak was identified at the time of the primary procedure, none of which developed a post-operative leak. No patient had any post-operative adverse outcomes that were attributed to Tachosil^®.

We believe this to be the largest case series evaluating the endoscopic use of Tachosil^® in skull base reconstruction. Our data show that in endoscopic transsphenoidal approach, Tachosil^® may be used safely in a multi-layered approach as an effective alternative to the NSF in low flow CSF leak cases, or alongside a NSF in higher flow leaks.