Double Layers Fat In Sellar Reconstruction After Pituitary Surgery

Background . Leakage of cerebrospinal fluid following endoscopic sellar approaches is a common and fatal complication. Many controversies existed for the best methods of reconstruction. Autologous fat is a widely used as a cheap, and available material which is simple technically to use, with a high success rate. Objective Assess the efficacy and morbidity of reconstruction of sellar defect with two layers of abdominal fat graft in trans-sphenoidal hypophysectomy Methodology This is a prospective cohort study in which 75 patients had endonasal endoscopic transsphenoidal approach for pituitary adenoma with intraoperative CSF leak were included. Arachnoid defect was graded according to its size. All grades of CSF leakage were repaired with two layers of abdominal fat; small one intradural to seal arachnoid defect and another larger supporting one introduced in an inlay technique for dural defect. Results Mean age was 54 years; 64% of cases were females. Non functional adenoma (66.7%) were most common type, 76% had suprasellar extension, and 81.3% were macro adenomas. Grade 1 arachnoid defect was present in 48% with zero incidence of postoperative leak. Grade2 in (38.6% of cases); 17.6% of them had postoperative leakage. Grade 3 (13.3% of cases); 20% of them had postoperative leakage. Overall success occurred in 91.7%. Conclusion Double layer abdominal fat reconstruction of the sella after endoscopic endonasal trans sphenoidal hypophysectomy is a reliable, easy, cheap, and fast method. It is highly effective in grade 1 and 2 CSF leaks. Grade 3 and direct leaks needs multilayer reconstruction from the start.