Collagen sponge repair of small cerebrospinal fluid leaks obviates tissue grafts and cerebrospinal fluid diversion after pituitary surgery

OBJECTIVE: Repair of a cerebrospinal fluid (CSF) leak created at the time o f transsphenoidal surgery typically involves placement of a fat, fascial, o r muscle graft and sellar floor reconstruction. In this report, a simplifie d repair for small, "weeping" CSF leaks using collagen sponge is described. METHODS: All patients underwent an endonasal transsphenoidal procedure usin g the operating microscope. At the completion of tumor removal, if a small CSF leak was noted but no obvious large arachnoidal defect was present, a p iece of collagen sponge was fashioned to cover the exposed diaphragma sella e. Titanium mesh was then wedged into the intrasellar, extradural space and a larger piece of collagen was placed over the reconstructed sellar floor. Nasal packing was removed within 24 hours. RESULTS: During an 18-month period, 62 consecutive transsphenoidal procedur es were performed for tumor removal. Of 20 patients with a small CSF leak ( 18 pituitary adenomas, 1 Rathke's cleft cyst, and 1 chordoma), all had succ essful repair with collagen sponge. At follow-up examinations at 1 to 18 mo nths, no patient had required a lumbar drain or had developed meningitis. O ne other patient had a large intraoperative arachnoidal defect that was uns uccessfully repaired with the collagen sponge technique; in this patient, a second operation was required with a fat graft, sellar floor reconstructio n, and lumbar drainage. CONCLUSION: A simplified repair of small CSF leaks after transsphenoidal su rgery using a two-layered collagen sponge technique with sellar floor reinf orcement is thought to be safe and effective and obviates the need for tiss ue grafts, fibrin glue, or lumbar drain placement.