Bone morphogenetic protein in the repair of cerebrospinal fluid leak after transsphenoidal surgery

The detailed surgical procedure of the transsphenoidal surgery for pituitary abscess has scarcely been described previously because it is a very rare clinical entity. The authors reported two cases of primary pituitary abscess. In case 1, the anterior wall of the sella turcica was reconstructed with the vomer bone after irrigating the abscess cavity, but the sella was not packed by fat for fear of the persistent infection by devascularized tissues. This led to the postoperative meningocele, the cerebrospinal fluid leak, and bacterial meningitis despite the successful abscess drainage. In case 2, tight sellar packing and reconstruction of the sellar wall were performed to avoid these postoperative complications, which resulted in complete drainage and uneventful postoperative course. Although accumulation of more cases is obviously needed to establish the definitive surgical technique in pituitary abscess surgery, our experience might suggest that packing of the sella is not impeditive for postoperative sufficient drainage.

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Repair of encephalocele and cerebrospinal fluid leak with the use of bone morphogenetic protein: A case report

Surgical Neurology International ◽

10.25259/sni-137-2019 ◽

2019 ◽

Vol 10 ◽

pp. 55 ◽

Cited By ~ 1

Author(s):

Dejan Slavnic ◽

Doris Tong ◽

Ryan Barrett ◽

Teck-Mun Soo

Keyword(s):

Cerebrospinal Fluid ◽

Bone Morphogenetic Protein ◽

Protein A ◽

Retrospective Chart Review ◽

Standard Technique ◽

Cerebrospinal Fluid Leak ◽

Sudden Onset ◽

Csf Leak ◽

Bony Defect ◽

Morphogenetic Protein

Background: Encephaloceles are rare phenomena which occur when brain parenchyma herniates through a skull defect which, if left untreated, may lead to significant issues such as cerebrospinal fluid (CSF) fistulas, meningitis, and intractable seizures. Due to the rarity and variety in size and location of encephaloceles, no standard technique has been established for the resultant defect. Herein, we demonstrate the safe and effective use of bone morphogenetic protein (BMP) in the repair of CSF leak caused by encephalocele. Case Description: A retrospective chart review was conducted on a 50-year-old female who presented with sudden onset spontaneous right nostril CSF leak due to the right lateral sphenoid sinus recess encephalocele, for which she underwent surgical repair. After resecting the encephalocele, cadaver crushed bone was used to fill the skull base defect. Following, an absorbable sponge from the extra-small BMP kit was cut in half and soaked with recombinant human BMP-2 (rhBMP-2) before being laid over the bony defect. On postoperative clinic visits at 2 weeks and at 3 months, the patient demonstrated good recovery without evidence of recurrent CSF leak. On follow-up computed tomography imaging at 9 months’ postsurgery, there was no evidence of recurrent CSF leak or encephalocele, infection, ectopic bone formation, excessive inflammation, or neoplasm. Conclusion: In this case, we demonstrate the successful use of BMP for the repair of CSF leak due to encephalocele. It is our extrapolation that the pro-inflammatory properties of rhBMP-2 lead to the prevention of recurrent CSF leak.

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