2025 Proffered Presentations
S134: GRADUATED REPAIR OF SKULL BASE DEFECTS IN ENDOSCOPIC PITUITARY ADENOMA SURGERY
Macarena Viñuela1; Claudia González1; Francisco Guarda2; Flavia Nilo2; Pablo Villanueva3; Claudio Callejas1; 1Otolaryngology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; 2Endocrinology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; 3Neurosurgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
Objectives: To describe the evolution and outcomes of our graded skull base repair protocol in endoscopic pituitary surgery.
Methods: Retrospective cohort study of 406 consecutive patients who underwent endoscopic pituitary surgery for adenoma at our institution. Repair protocol underwent two modifications, delineating three distinct study periods. From 2013-2016, it was tailored exclusively on the grade of intraoperative cerebrospinal fluid (CSF) leaks. Subsequently (2017-2019), descent of the sellar diaphragm was incorporated. Since 2020, preoperative risk factors for postoperative CSF leak (obesity, revision surgery, and prior irradiation) were included. Materials employed in cranial base repair were modified accordingly.
Results: Postoperative CSF leak rate decreased across study periods; 12.5% (14/112), 6.2% (7/113) and 2.2% (4/181), respectively. This difference was statistically significant between the first and the last period. Overall, CSF leak incidence was 6.2% (25/406), CNS infection 0.7% (3/406) and mortality rate 0.2% (1/406). Among study periods, intrasellar fat graft utilization increased from 44.6% (50/112), 77.9% (88/113) and 84.0% (152/181). Vascularized flaps were employed in 20.5% (23/112), 52.2% (59/113), and 47.5% (86/181). Nasoseptal flap was the predominant choice. Dural substitute use decreased progressively: 81.2% (82/112), 55.4% (51/113), and 7.2% (13/181).
Conclusions: The learning curve and refinement of our graded skull base repair protocol resulted in a substantial reduction in the postoperative CSF leak rate. The presence and magnitude of intraoperative CSF leaks, diaphragm exposure, and preoperative risk factors for postoperative CSF leaks were useful variables for guiding skull base reconstruction after pituitary surgery.