Endoscopic transsphenoidal surgery reconstruction using the fibrin sealant patch Tachosil(R)

Introduction The incidence of CSF leak following endoscopic transsphenoidal surgery remains the most important measure in the success of any repair. The nasoseptal flap (NSF) has played a pivotal role in reconstructing defects. However, morbidity associated with the NSF includes bleeding, septal injury, altered smell and crusting. Tachosil(R) is an absorbable fibrin sealant patch that promotes haemostasis and wound healing. The purpose of this study was to evaluate the effectiveness of Tachosil(R) to repair intraoperative defects during an endoscopic transsphenoidal approach. Materials and methods All patients who underwent an endoscopic transsphenoidal approach with the use of Tachosil(R) at the Queen Elizabeth Hospital Birmingham, between January 2013 and June 2020 were retrospectively analysed. Tachosil(R) was used as an overlay patch over of the bony defect, in a multi-layered repair depending on the defect and grade of CSF leak. The primary outcome measure was post-operative CSF leak. Results A total of 52 primary procedures where Tachosil(R) was used as the overlay were analysed. There were 23 (44.2%) intraoperative CSF leaks. The overall post-operative CSF leak rate was 7.8% (n = 4), with all cases having had a Tachosil(R) overlay reconstruction with no NSF. A formal NSF was harvested in only five cases alongside the Tachosil(R) patch, where a grade 2 or more leak was identified at the time of the primary procedure, none of which developed a post-operative leak. No patient had any post-operative adverse outcomes that were attributed to Tachosil(R). Conclusions We believe this to be the largest case series evaluating the endoscopic use of Tachosil(R) in skull base reconstruction. Our data show that in endoscopic transsphenoidal approach, Tachosil(R) may be used safely in a multi-layered approach as an effective alternative to the NSF in low flow CSF leak cases, or alongside a NSF in higher flow leaks.