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Arachnoid Prolapse in Endoscopic Transsphenoidal Surgery of Pituitary Adenoma, Technical Note Publisher Pubmed



Sharifi G1, 2 ; Akbari Dilmaghani N2, 3 ; Sadrhosseini SM4 ; Arastou S2
Authors
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Authors Affiliations
  1. 1. Department of Neurosurgery, Loghman Hakim Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  2. 2. Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  3. 3. Department of Otolaryngology, Head and Neck Surgery, Loghman Hakim Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  4. 4. Department of Otolaryngology, Head and Neck Surgery, Vali-e Asr Educational Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

Source: British Journal of Neurosurgery Published:2023


Abstract

Purpose: An arachnoid prolapse after endoscopic transsphenoidal surgery for a pituitary adenoma is an uncommon, but important, phenomenon which should be managed. We have evaluated the efficacy of a new simple technique to correct the prolapsed arachnoid following endoscopic surgery of pituitary adenomas. Methods: A total of 1352 patients with pituitary adenomas, 24–76 years old, who underwent full endoscopic transsphenoidal surgeries between February 2014 and February 2019 in Erfan and Loghman Hakim hospitals. 46 patients with arachnoid prolapse participated in this study and41 patients completed the study. Arachnoid prolapse was repaired by bipolar cauterization with either autologous fat grafts (36 patients) or without autologous fat grafts (5patients). Results: Of 41 patients who completed the study, all except one, had large adenomas with significant suprasellar extension and enlarged diaphragma sellae. All patients had arachnoid prolapse at the end of the tumor removal stage and 13 patients had very minor intraoperative CSF leakage. Prolapsed arachnoid was repaired using a bipolar cautery with or without the autologous fat graft. During the postoperative follow-up period, none of the patient experienced early or delayed postoperative CSF leakage, meningitis, visual deterioration, delayed epistaxis, cranial nerve palsy, recurrence, or death. Conclusion: Bipolar cauterization is a safe, effective technique to repair a suprasellar arachnoid prolapse during reconstruction of the sellar floor following endoscopic transsphenoidal pituitary surgery. © 2020 The Neurosurgical Foundation.