Simple dural closure using a knotless barbed suture in endoscopic transsphenoidal surgery: preliminary experience

Abstract

Background: Several literatures reported that suturing dura was reliable in preventing cerebrospinal fluid (CSF) leak in transsphenoidal surgery. However, suturing and knotting is technically challenging and time consuming in the transsphenoidal approach.

Objectives: To simplify the dural suturing procedure, a preliminary study of barbed suturing in endoscopic transsphenoidal surgery was introduced.

Material and methods: We retrospectively reviewed the patients underwent dural closure using knotless suturing after endoscopic transsphenoidal surgery from August 2015 to September 2018. In the cases of no or low-flow CSF leak (Kelly’s classification grade 0–2), the dura was sutured to restore anatomic structure and prevent postoperative CSF leak. In the cases of high-flow CSF leak (Kelly’s classification grade 3), multilayered reconstruction including dural suturing was performed. The suturing time, intra- and postoperative CSF leak were recorded.

Results: Thirty-three patients underwent dural barbed suturing. The mean suturing time was about 10 min. Intraoperative CSF leak was encountered in 16 patients, including 7 patients with grade 1 CSF leak, 5 patients with grade 2 CSF leak and 4 patients with grade 3 CSF leak. No one developed into postoperative CSF leak.

Conclusion: Dural closure using a barbed suture is a simply and reliable technique.

Chinese abstract

背景：若干文献已报道, 硬脑膜缝合对于经蝶窦手术中防止脑脊液（CSF）泄漏是可靠的。然而, 在这种手术中, 缝合和打结在技术上既有难度且耗时太久。

目的：为简化硬脑膜缝合过程, 对内镜经蝶窦手术中的倒钩缝合进行了初步研究。

材料和方法：我们回顾性分析了2015年8月至2018年9月期间内镜经蝶窦手术后采用无结缝合来封闭硬脑膜的患者。在无或低流量CSF漏出（凯利分类等级为0–2）的情况下, 通过缝合硬脑膜来恢复解剖结构并防止术后脑脊液漏出。对于高流量CSF泄漏（凯利分类等级为3）, 进行了包括硬脑膜缝合的多层重建。记录缝合时间以及术中和术后脑脊液泄漏。

结果：33例患者接受了硬膜倒钩缝合。平均缝合时长约为10分钟。术中发生CSF泄漏的有16例, 包括7例1级CSF泄漏, 5例2级CSF泄漏和4例3级 CSF泄漏。没有人发展成术后脑脊液泄漏。

结论：使用倒钩缝合硬膜封闭术是一种简单而可靠的技术。

Keywords:

• Endoscopic transsphenoidal surgery
• barbed suture
• cerebrospinal fluid leak
• dural repair

Disclosure statement

No potential conflict of interest was reported by the authors.