COMPUTED TOMOGRAPHY-GUIDED TRANSSPHENOIDAL CLOSURE OF POSTSURGICAL CEREBROSPINAL-FLUID FISTULA - A TRANSMUCOSAL NEEDLE TECHNIQUE

BACKGROUND Cerebrospinal fluid (CSF) fistula represents a fearful comp lication of transsphenoidal surgery and, despite careful intraoperativ e repair and prolonged postoperative lumbar CSF drainage, need for a n ew surgical intrasphenoidal plasty is not uncommon. METHODS These case s prompted us to develop a simple, minimally invasive, harmless repeat able technique consisting of a computed tomography (CT)-guided intrasp henoidal injection of fibrin glue through a 12-gauge spinal needle. RE SULTS Five patients presenting with rhinoliquorrhea following a transs phenoidal approach for the excision of pituitary adenomas (three cases ) and craniopharyngiomas (two cases) were treated successfully with th e presented technique. In two cases the first attempt attained only pa rtial success and therefore the procedure was repeated, In the last tw o cases, the injection of fibrin glue was preceded by 2 cc of fresh au tologous blood, with the aim of enhancing the mechanisms of healing, p ossibly inducing adhesions and fibrosis. CONCLUSIONS The proposed meth od of treatment for CSF leakage following transsphenoidal surgery may represent a valid alternative to the surgical option. (C) 1997 by Else vier Science Inc.