The application of n-butyl 2-cyanoacrylate to repair CSF fistulas for 221 patients who underwent transsphenoidal surgery.

Background: The adequate repair of intraoperative CSF leaks during transsphenoidal surgery remains a challenge. The authors describe the application of N-butyl 2-cyanoacrylate (cyanoacrylate) tissue glue for repair of CSF fistulas during transsphenoidal surgery.

Methods: The authors retrospectively reviewed the records of 221 consecutive patients who underwent transsphenoidal surgery during 1998-2007. Among these patients, 52 (24%) experienced detectable intraoperative CSF leakage. The CSF fistulas were graded on a scale of 1-3, according to the amount of CSF loss and extent of diaphragmatic disruption. 39 patients who had an average leak scale of 1.28 received cyanoacrylate glue to seal the floor. The remaining 13 patients who were not part of this report received other dura sealant substitutes, including Tisseel and Dura Seal, or fat/cartilage grafts without any additional glue material.

Results: 4 of 221 patients (2%) who underwent surgery had postoperative CSF fistula. Of the 39 patients who underwent repair of their fistula using fat graft, cartilage/bone buttress and cyanoacrylate reconstruction, 2 (5.13%) developed postoperative CSF fistulas without any other side effects. The average intraoperative leak grade in these 2 patients was 2.00.

Conclusions: The authors used cyanoacrylate glue for intraoperative repair of higher grade CSF fistulas. As an adjunct to careful sellar reconstruction, cyanoacrylate glue appears to be effective and safe in preventing postoperative CSF leakage after transsphenoidal surgery.