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Fat and Fibrin Glue: Quo Vadis?

INTRODUCTION
Up to date, there are few conditions where the nasoseptal flap (NSF) is not considered as a valid option in the reconstructive phase: 1) when the neurosurgeon does not use an endoscopic technique or 2) when the neurosurgeon uses the endoscopic technique, but there is no genuine indication for the mentioned flap. Therefore, the young skull base neurosurgeon is challenged to master other techniques (other than NSF) for the reconstructive phase. This study aims to analyze the effectiveness of fat and fibrin glue to prevent postoperative CSF leak in pituitary surgery.


METHODS
Two hundred and eleven patients affected by pituitary adenoma entered this study. Patients that underwent a microscopic transsphenoidal approach between January 2013 and April 2019 were included. All the patients that developed intraoperative CSF leak were treated with fat and fibrin glue. The presence or absence of postoperative CSF leak was considered as a parameter to test the effectiveness of the intraoperative reconstruction technique used.


RESULTS
Postoperative CSF leak was observed in 5 patients (2,4%). Among patients with an intraoperative low- grade CSF leak (1 or 2), 97,9% did not develop a postoperative CSF leak. In contrast, those who presented an intraoperative CSF leak of grade 3, had a worse prognosis.


CONCLUSION
Fat and fibrin glue is currently an effective method in the treatment of low-grade intraoperative CSF leak. In case of intraoperative CSF leak of grade 3, it should be used combined with the NSF technique to obtain a safer reconstruction.