Collagen sponge is as effective as autologous fat for grade 1 intraoperative cerebral spinal fluid leakage repair during transsphenoidal surgery

Ming Shen; Nidan Qiao; Xuefei Shou; Zhengyuan Chen; Wenqiang He; Zengyi Ma; Zhao Ye; Yichao Zhang; Qilin Zhang; Xiang Zhou; Xiaoyun Cao; Yao Zhao; Shiqi Li; Yongfei Wang

doi:10.1016/j.clineuro.2022.107131

Collagen sponge is as effective as autologous fat for grade 1 intraoperative cerebral spinal fluid leakage repair during transsphenoidal surgery

Clin Neurol Neurosurg. 2022 Mar:214:107131. doi: 10.1016/j.clineuro.2022.107131. Epub 2022 Jan 13.

Authors

Ming Shen¹, Nidan Qiao¹, Xuefei Shou², Zhengyuan Chen¹, Wenqiang He¹, Zengyi Ma¹, Zhao Ye¹, Yichao Zhang¹, Qilin Zhang¹, Xiang Zhou¹, Xiaoyun Cao¹, Yao Zhao¹, Shiqi Li¹, Yongfei Wang³

Affiliations

¹ Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China; Neurosurgical Institute of Fudan University, Shanghai 200040, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai 200040, China; Shanghai Pituitary Tumor Center, Shanghai 200040, China; National Center for Neurological Disorders, China; Research Units of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery (2018RU008), Chinese Academy of Medical Sciences, China.
² Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China; Neurosurgical Institute of Fudan University, Shanghai 200040, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai 200040, China; Shanghai Pituitary Tumor Center, Shanghai 200040, China; National Center for Neurological Disorders, China; Research Units of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery (2018RU008), Chinese Academy of Medical Sciences, China. Electronic address: shouxf@sina.com.
³ Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China; Neurosurgical Institute of Fudan University, Shanghai 200040, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai 200040, China; Shanghai Pituitary Tumor Center, Shanghai 200040, China; National Center for Neurological Disorders, China; Research Units of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery (2018RU008), Chinese Academy of Medical Sciences, China. Electronic address: eamns@hotmail.com.

PMID: 35134707
DOI: 10.1016/j.clineuro.2022.107131

Abstract

Objective: To compare the efficacy of collagen sponge graft versus autologous fat graft in repairing grade 1 intraoperative CSF leakage and identify potential risk factors for failure repairing.

Methods: We retrospectively recruited patients with grade 1 intraoperative CSF leakage repaired either with a collagen sponge (Group A), with autologous fat graft (Group B), or with only bipolar coagulation and gel foam packing (Group C). Patients with previous radiotherapy, repaired with additional materials, received postoperative lumbar drainage or without sufficient follow-up data were excluded. The primary outcome was the incidence of postoperative CSF leakage. We used propensity score matching to adjust for confounding when comparing Group A and Group B.

Results: 459 patients (277 female and 182 male) were recruited. Among them, 296 patients were in Group A, 146 patients were in Group B, and the other 17 patients were in Group C. After propensity score matching, 146 and 146 patients were included in group A and group B, respectively. No difference was observed for the primary outcome in the matched cohort (p = 0.654) with three patients in Group A (1.0% and 2.1% before and after matching, respectively) and two patients in Group B (1.4% and 1.4% before and after matching, respectively) developed postoperative CSF leakage, respectively. Patients repaired only with gel foam and/or bipolar coagulation (OR 770.5, p < 0.001) and older age (OR 1.16, p < 0.001) were associated with a higher likelihood of postoperative CSF leakage.

Conclusions: Collagen sponge is as effective as an autologous fat graft for grade 1 intraoperative CSF leakage repair during transsphenoidal surgery. Repair with gel foam and/or bipolar coagulation and older age are associated with a higher likelihood of postoperative CSF leakage.

Keywords: Cerebral spinal fluid leakage; Collagen sponge; Propensity score; Repair; Transsphenoidal surgery.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cerebrospinal Fluid Leak* / complications
Cerebrospinal Fluid Leak* / surgery
Collagen / therapeutic use
Drainage / adverse effects
Female
Humans
Male
Postoperative Complications* / epidemiology
Retrospective Studies

Substances

Collagen