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Neuroendocrinologia | Trabalhos em Congressos

CLOSURE OF INTRAOPERATIVE LOW-FLOW CSF LEAKS USING FIBRIN GLUE ALONE AND NO LUMBAR DRAINAGE DURING TRANSESPHENOIDAL SURGERY

Liberman B; Nogueira KC; Huayllas MC; Goldman J; Cukiert A; Burattini JA.

Departments of Endocrinology and Neurosurgery, Hospital Brigadeiro, Sao Paulo SP, Brazil

Introduction: The closure of CSF leaks during transesphenoidal surgery might represent a challenge. Persistent CSF leak might lead to meningitis and often needs reoperation. We recently published on the use of fibrin glue alone (without any grafting) and lumbar drainage as a technique for closing these leaks. In this paper, we present the results of closing low-flow CSF leaks with fibrin glue alone without lumbar drainage or any type of grafting.

Methods: Thirty consecutive patients submitted to transesphenoidal surgery in whom an intraoperative low-flow CSF leak was noted were studied. We considered a “low-flow” intraoperative leak those leaks which were visually sealed after the application of haemostatic material (surgical) and fibrin glue. A two-layer seal including haemostatic material/fibrin glue was used in all patients. No graft or lumbar drainage was used. Patient were ask to remain in bed for 2 days.

Results: No postoperative CSF leak was noted in these patients. There was no meningitis and no need for reoperation in this series.

Discussion: No grafting or lumbar drainage is needed for the treatment of low-flow intraoperative CSF leaks occurring during transesphenoidal surgery. Lumbar drainage might be needed in high-flow intraoperative CSF leaks.