Endoscopic application of autologous fibrin glue to treat postoperative CSF leak after expanded endonasal approach: Report of two cases

Abstract

Since the introduction of endoscopic surgery for the treatment of skull base lesions, one of the main issues has been the CSF leak. The implementation of efficient reconstructive techniques has reduced the post-operative CSF leak rate. However, none of the techniques for closure has proved to be totally effective in preventing CSF leakage. We propose a possible solution to this problem.Two patients underwent surgery for suprasellar meningioma via an expanded endoscopic endonasal approach and subsequently presented post-operative CSF leakage. They were treated via injections of autologous fibrin glue at the patients' bedside. The autologous fibrin glue was obtained using the automated Vivostat® system, that prepares 5 ml of autologous fibrin sealant from 120 ml of the patient's own blood.In both patients, we obtained the permanent closure of the small defects and the interruption of the leakage.The application of autologous fibrin glue made it possible to successfully treat these two cases of postoperative CSF leak without the need of a second operation. The advantage of using autologous fibrin glue is probably related to the high biological activity of such material in promoting a faster healing, it might be a solution in selected cases. Keywords: Skull base reconstruction, Flaps, Autologous fibrin glue