Wrapping method for better fat handling in endoscopic trans-sphenoidal surgery

Area of Science:

• Neurosurgery
• Surgical Techniques
• Biomaterials

Background:

• Cerebrospinal fluid (CSF) leakage is a complication of endoscopic transsphenoidal surgery (ETSS).
• Autologous fat grafts are commonly used to prevent CSF leakage but can be difficult to handle due to their soft and slippery nature.
• Improved methods for fat graft manipulation are needed to enhance surgical safety and efficacy in ETSS.

Purpose of the Study:

• To evaluate the efficacy of a novel method involving wrapping autologous fat grafts with Surgicel® for improved handling during ETSS.
• To determine if this technique reduces the incidence of postoperative CSF leakage.

Main Methods:

• Autologous fat tissue was harvested and cut into 5 mm pieces.
• Surgicel® was cut into 2.5 cm² sections and used to encase the fat pieces.
• The wrapped fat grafts were slightly moistened with saline solution before implantation during ETSS.

Main Results:

• A total of 34 patients underwent ETSS between January 2023 and August 2024.
• Patient age ranged from 18 to 86 years, with an average of 54.9 years.
• No instances of postoperative CSF leakage were observed in any of the patients (0% incidence).

Conclusions:

• The Surgicel® wrapping technique significantly improves the handling characteristics of fat grafts during ETSS.
• This method appears to be highly effective in preventing CSF leakage following ETSS.
• The technique offers a practical solution for surgeons performing ETSS requiring fat grafting.