Reconstruction of dural defects after endoscopic transsphenoidal resection of sellar region tumors

Background . Endoscopic transnasal transsphenoidal surgery (standart/extended) is commonly used for resection tumors in the sellar and parasellar regions. However, because of its anatomical location, cerebrospinal fluid leakage (CSF) is a major complication of this approach. Skull base reconstruction after endoscopic transsphenoidal surgery is essential to prevent postoperative CSF leakage. Aim . To determine specific recommendations and develop an algorithm for dural reconstruction after tumor removal in the sellar region. Materials and methods . All patients who were treated at Nagoya University Hospital from April 2013 to March 2017 who underwent sellar floor reconstruction using dural suturing with abdominal fat or fascia after tumor removal via a standard and extended endoscopic transsphenoidal approach were included in the study. Results . Endoscopic transsphenoidal surgery was performed in 176 patients (the standard transsphenoidal approach was used for 141 patients and the extended transsphenoidal approach was used for 35 patients). In 76 patients, intraoperative CSF leak was classified as grade 2 and 3 according to Esposito. There were 3 cases of CSF leakage after the surgery (1.7 %). Conclusion . Dural suturing is a basic and key method of skull base reconstruction, with continuous suturing being the most effective approach. Due to the localization of tumors, we developed a differentiated approach and algorithm for dural reconstruction after tumor removal in the sellar region.