Abstract
Background: In transsphenoidal endoscopic endonasal surgery (TEES), watertight separation of the sinonasal cavity and intracranial compartment is the primary goal of closure. However, even when meticulous closure technique is implemented, cerebrospinal fluid (CSF) leaks, dural scarring, and meningitis may result. Particularly when intraoperative CSF leak occurs, materials that facilitate the creation of a watertight seal that inhibits disease transition and minimizes inflammatory response after durotomy are sought. Dehydrated amniotic membrane (DAM) allograft appears to confer these attributes as studies have shown it augments epithelialization, facilitates wound healing, and minimizes and impedes bacterial growth. We detail the use of DAM allograft to augment sellar closures after TEES. Methods: We conducted a feasibility study, retrospectively reviewing our institution’s database of TEES for resection of pituitary adenomas in which DAM was utilized to supplement sellar closure. Results: One hundred twenty transsphenoidal surgery cases with DAM were used during sellar closure, with a 49.2% intraoperative CSF leak rate. Of this cohort, two patients experienced postoperative CSF leak (1.7%), and no patients developed meningitis. CSF leak rate for TEES-naïve patients was 0.9%. Conclusions: This feasibility study demonstrates that dehydrated amniotic membrane allograft can be safely utilized as an adjunct during sellar closures for TEES for pituitary adenoma resection with very low rates of CSF leak and meningitis.
| Original language | English (US) |
|---|---|
| Journal | Acta Neurochirurgica |
| DOIs | |
| State | Accepted/In press - Jan 1 2019 |
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Keywords
- Brain tumor
- Cerebrospinal fluid leak
- Dehydrated amniotic membrane
- Dural repair
- Pituitary adenoma
- Skull base
ASJC Scopus subject areas
- Surgery
- Clinical Neurology
Cite this
The use of dehydrated amniotic membrane allograft for augmentation of dural repair in transsphenoidal endoscopic endonasal resection of pituitary adenomas. / Eichberg, Daniel G.; Richardson, Angela M.; Brusko, G. Damian; Ali, Sheikh C.; Buttrick, Simon S.; Shah, Ashish H.; Alam, Elie S.; Sargi, Zoukaa B; Komotar, Ricardo J.
In: Acta Neurochirurgica, 01.01.2019.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The use of dehydrated amniotic membrane allograft for augmentation of dural repair in transsphenoidal endoscopic endonasal resection of pituitary adenomas
AU - Eichberg, Daniel G.
AU - Richardson, Angela M.
AU - Brusko, G. Damian
AU - Ali, Sheikh C.
AU - Buttrick, Simon S.
AU - Shah, Ashish H.
AU - Alam, Elie S.
AU - Sargi, Zoukaa B
AU - Komotar, Ricardo J
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Background: In transsphenoidal endoscopic endonasal surgery (TEES), watertight separation of the sinonasal cavity and intracranial compartment is the primary goal of closure. However, even when meticulous closure technique is implemented, cerebrospinal fluid (CSF) leaks, dural scarring, and meningitis may result. Particularly when intraoperative CSF leak occurs, materials that facilitate the creation of a watertight seal that inhibits disease transition and minimizes inflammatory response after durotomy are sought. Dehydrated amniotic membrane (DAM) allograft appears to confer these attributes as studies have shown it augments epithelialization, facilitates wound healing, and minimizes and impedes bacterial growth. We detail the use of DAM allograft to augment sellar closures after TEES. Methods: We conducted a feasibility study, retrospectively reviewing our institution’s database of TEES for resection of pituitary adenomas in which DAM was utilized to supplement sellar closure. Results: One hundred twenty transsphenoidal surgery cases with DAM were used during sellar closure, with a 49.2% intraoperative CSF leak rate. Of this cohort, two patients experienced postoperative CSF leak (1.7%), and no patients developed meningitis. CSF leak rate for TEES-naïve patients was 0.9%. Conclusions: This feasibility study demonstrates that dehydrated amniotic membrane allograft can be safely utilized as an adjunct during sellar closures for TEES for pituitary adenoma resection with very low rates of CSF leak and meningitis.
AB - Background: In transsphenoidal endoscopic endonasal surgery (TEES), watertight separation of the sinonasal cavity and intracranial compartment is the primary goal of closure. However, even when meticulous closure technique is implemented, cerebrospinal fluid (CSF) leaks, dural scarring, and meningitis may result. Particularly when intraoperative CSF leak occurs, materials that facilitate the creation of a watertight seal that inhibits disease transition and minimizes inflammatory response after durotomy are sought. Dehydrated amniotic membrane (DAM) allograft appears to confer these attributes as studies have shown it augments epithelialization, facilitates wound healing, and minimizes and impedes bacterial growth. We detail the use of DAM allograft to augment sellar closures after TEES. Methods: We conducted a feasibility study, retrospectively reviewing our institution’s database of TEES for resection of pituitary adenomas in which DAM was utilized to supplement sellar closure. Results: One hundred twenty transsphenoidal surgery cases with DAM were used during sellar closure, with a 49.2% intraoperative CSF leak rate. Of this cohort, two patients experienced postoperative CSF leak (1.7%), and no patients developed meningitis. CSF leak rate for TEES-naïve patients was 0.9%. Conclusions: This feasibility study demonstrates that dehydrated amniotic membrane allograft can be safely utilized as an adjunct during sellar closures for TEES for pituitary adenoma resection with very low rates of CSF leak and meningitis.
KW - Brain tumor
KW - Cerebrospinal fluid leak
KW - Dehydrated amniotic membrane
KW - Dural repair
KW - Pituitary adenoma
KW - Skull base
UR - http://www.scopus.com/inward/record.url?scp=85070107622&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85070107622&partnerID=8YFLogxK
U2 - 10.1007/s00701-019-04008-x
DO - 10.1007/s00701-019-04008-x
M3 - Article
C2 - 31372758
AN - SCOPUS:85070107622
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
SN - 0001-6268
ER -