Comparative study of sella closure with autologous free fat graft only in intra operative CSF leak

Muhammad Burhan Ud din Janjua, Inayat Ullah Khan Department of Neurosurgery, Shifa International Hospital, Islamabad, Pakistan. ABSTRACT Objective To present the local experience of fat graft use for sella closure in case of intraoperative CSF leak to prevent the post operative CSF rhinorrhea. Patient and Methods We retrospectively studied 22 cases operated for pituitary adenomas from 2004 to 2008. Transsphenoidal hypophysectomy was performed with construction of sella floor with autologous free fat graft in patients with intraoperative CSF leak. All patients were followed after one, three and six month of surgery. The out come was assessed by follow up MRI scan. Results Male to female ratio was 2:1 and age of patients ranged from 15 to 74 years (mean 46 years). Intraoperative CSF leakage was observed in 8 cases. No post operative CSF leakages was observed in any one. Three out of 22 patients had microadenoma while rest had macroadenoma. Only 5 patients had functioning adenoma. 4 had prolactinoma and 1 each had growth hormone producing adenoma and ACTH producing adenoma. Post operative complications were noted in 13 patients. Only 2 patients had revision procedure done. Conclusion The technique of covering the sella membrane and dural defects with the use of free fat graft in the case of intraoperative CSF leakage appeared to be most reliable and cost effective technique for intraoperative CSF leak. (Rawal Med J 2010;35: ).