Epidural Interlay Graft for Pituitary Surgery: A 4-Year Institutional Experience

Area of Science:

• Neurosurgery
• Endocrinology

Background:

• Postoperative cerebrospinal fluid (CSF) leaks are a complication of endoscopic transsphenoidal pituitary surgery.
• Various sellar repair techniques exist, differing in complexity and effectiveness.

Purpose of the Study:

• To evaluate the efficacy of a minimalistic sellar repair technique using an epidural interlay graft.
• To assess the incidence of CSF leaks and the need for adjunct repair methods.

Main Methods:

• Retrospective review of 334 consecutive endoscopic transsphenoidal pituitary surgeries.
• Sellar repair exclusively utilized an epidural interlay graft.
• Analysis of patient/tumor characteristics, CSF leak incidence, and repair techniques.

Main Results:

• Postoperative CSF leak occurred in only 0.3% of cases (1/334).
• An epidural interlay graft alone successfully repaired 70 intraoperative CSF leaks, including 13 high-flow leaks.
• Use of fat grafts, nasoseptal flaps, and lumbar drains significantly decreased over time.

Conclusions:

• A simple epidural interlay graft is highly effective for sellar repair, preventing postoperative CSF leaks even in high-flow intraoperative cases.
• This minimalistic approach reduces reliance on more complex techniques and adjuncts.
• Zero postoperative CSF leaks were observed in over 300 consecutive surgeries using this method.