The use of dehydrated amniotic membrane allograft for augmentation of dural repair in transsphenoidal endoscopic endonasal resection of pituitary adenomas

Daniel G. Eichberg, Angela M. Richardson, G. Damian Brusko, Sheikh C. Ali, Simon S. Buttrick, Ashish H. Shah, Elie S. Alam, Zoukaa B Sargi, Ricardo J Komotar

Research output: Contribution to journalArticle

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 languageEnglish (US)
JournalActa Neurochirurgica
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Amnion
Pituitary Neoplasms
Allografts
Meningitis
Feasibility Studies
Wound Healing
Cicatrix
Cerebrospinal Fluid Leak
Databases
Growth

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 journalArticle

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. / The use of dehydrated amniotic membrane allograft for augmentation of dural repair in transsphenoidal endoscopic endonasal resection of pituitary adenomas. In: Acta Neurochirurgica. 2019.
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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-na{\"i}ve 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.",
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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

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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.

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