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Acta Neurochirurgica

, Volume 161, Issue 10, pp 2117–2122 | Cite as

The use of dehydrated amniotic membrane allograft for augmentation of dural repair in transsphenoidal endoscopic endonasal resection of pituitary adenomas

  • Daniel G. EichbergEmail author
  • Angela M. Richardson
  • G. Damian Brusko
  • Sheikh C. Ali
  • Simon S. Buttrick
  • Ashish H. Shah
  • Elie S. Alam
  • Zoukaa B. Sargi
  • Ricardo J. Komotar
Original Article - Brain Tumors
Part of the following topical collections:
  1. Brain tumors

Abstract

Background

In transsphenoidal endoscopic endonasal surgery (TEES), watertight separation of the sinonasal cavity and intracranial compartment is the primary goal of closure. However, even when meticulous closure technique is implemented, cerebrospinal fluid (CSF) leaks, dural scarring, and meningitis may result. Particularly when intraoperative CSF leak occurs, materials that facilitate the creation of a watertight seal that inhibits disease transition and minimizes inflammatory response after durotomy are sought. Dehydrated amniotic membrane (DAM) allograft appears to confer these attributes as studies have shown it augments epithelialization, facilitates wound healing, and minimizes and impedes bacterial growth. We detail the use of DAM allograft to augment sellar closures after TEES.

Methods

We conducted a feasibility study, retrospectively reviewing our institution’s database of TEES for resection of pituitary adenomas in which DAM was utilized to supplement sellar closure.

Results

One hundred twenty transsphenoidal surgery cases with DAM were used during sellar closure, with a 49.2% intraoperative CSF leak rate. Of this cohort, two patients experienced postoperative CSF leak (1.7%), and no patients developed meningitis. CSF leak rate for TEES-naïve patients was 0.9%.

Conclusions

This feasibility study demonstrates that dehydrated amniotic membrane allograft can be safely utilized as an adjunct during sellar closures for TEES for pituitary adenoma resection with very low rates of CSF leak and meningitis.

Keywords

Dehydrated amniotic membrane Dural repair Brain tumor Skull base Cerebrospinal fluid leak Pituitary adenoma 

Abbreviations

TEES

Transsphenoidal endoscopic endonasal surgery

CSF

Cerebrospinal fluid

DAM

Dehydrated amniotic membrane

FDA

Food and Drug Administration

NSF

Nasoseptal flap

Notes

Acknowledgments

The authors would like to thank Linda Alberga for manuscript preparation, and Roberto Suazo for video editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

“For this type of study, formal consent is not required.”

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Daniel G. Eichberg
    • 1
    • 2
    Email author
  • Angela M. Richardson
    • 1
  • G. Damian Brusko
    • 3
  • Sheikh C. Ali
    • 4
  • Simon S. Buttrick
    • 1
  • Ashish H. Shah
    • 1
  • Elie S. Alam
    • 5
  • Zoukaa B. Sargi
    • 5
  • Ricardo J. Komotar
    • 1
  1. 1.Department of Neurological SurgeryUniversity of Miami Miller School of MedicineMiamiUSA
  2. 2.Department of Neurological SurgeryUniversity of Miami School of MedicineMiamiUSA
  3. 3.University of Miami Miller School of MedicineMiamiUSA
  4. 4.College of Osteopathic MedicineNova Southeastern UniversityFt. LauderdaleUSA
  5. 5.Department of OtolaryngologyUniversity of Miami Miller School of MedicineMiamiUSA

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