Table 5.
Descriptive comparison of reconstruction outcomes with other series.
| Study | Study type | Sample Size | Tumor type | Surgical approach | Intraop leak grading | Reconstruction strategy (by grade) | Overall postop CSF leak rate | Postop leak rate in intraop leak group | Meningitis rate | Prophylactic LD use |
|---|---|---|---|---|---|---|---|---|---|---|
| Baussart et al. (33) | Retrospective, single-center | 3015 | Pituitary adenoma | Standard | Modified Esposito | Oozing: TachoSil | 1% | 3.4% (11/319) | 0.8% | Abandoned (replaced by Foley balloon after 2014) |
| Low-flow: Epidural graft (middle turbinate/fascia lata) | ||||||||||
| High-flow: Intrasellar fascia + muscle | ||||||||||
| High-risk (BMI > 40, redo, prior RT): Foley balloon or double NSF | ||||||||||
| Zhang et al. (34) | Retrospective, single-center | 703 | Pituitary adenoma | Standard | Esposito-Kelly grade 0-3 | G1: Fat packing + artificial dura | 0.14% | 1.16% (1/86, only in G2) |
Not reported | None |
| G2: “Bathtub plug” fat + artificial dura | ||||||||||
| G3: Autologous fascia continuous suturing + NSF | ||||||||||
| Shen et al. (32) | Retrospective with PSM | 459 (all G1) |
Pituitary adenoma (92.4%), Rathke's cyst, craniopharyngioma |
Standard | Only grade 1 | Group A: Collagen sponge (“baseball cap” technique) | 2.4% (in G1 patients) |
Group A: 1.0%, Group B: 1.4%, Group C: 35.3% | Not reported | Excluded (patients with LD were excluded) |
| Group B: Autologous fat graft | ||||||||||
| Group C: Gel foam + bipolar coagulation only | ||||||||||
| Zeden et al. (15) | Retrospective, single-center | 30 | Pituitary macroadenoma (25), Rathke's cyst (5) |
Standard | Custom 4-tier (-, +, ++, +++) | Sellar filling (grade-dependent): GS/CM/ OC/abdominal fat | 3.3% (1/30) | leak occurred in patient with no intraop leak | 0% | None |
| All grades: Rigid epidural PDS foil + fibrin glue | ||||||||||
| Fishpool et al. (35) | Prospective, single-center | 32 | Pituitary adenoma | Standard | Not formally graded | All grades: Free middle turbinate mucosal graft + Tisseel (fibrin glue) + Gelfoam packing (no rigid buttress, no nasal packing, no LD) | 0% (0/32) | 3 intraop leaks, all repaired successfully | Not reported | None |
| Scagnelli et al. (36) | Retrospective, single-center | 122 | Pituitary adenoma | Standard | Not formally graded (low vs. high flow) | All low-grade leaks: Nasal floor free mucosal graft (overlay) + Durepair (inlay) | 0.82% (1/122) | Not reported (39% intraop leak rate) | Not reported | None |
| High-flow (cistern opened): NSF (9 cases, excluded from this group) | ||||||||||
| This study | Retrospective, single-center | 213 | Pituitary adenoma | Standard | Esposito-Kelly grade 0-3 | Triple-layer (all grades, no autograft, no NSF): Artificial dura (overlay) + gelatin sponge packing + biological protein gel sealing | 1.41% | G1: 2.4% (1/41), G2: 4.4% (2/45), G3: 0% (0/11) | 1.88% | None |
Direct comparisons across studies are limited by differences in patient populations, surgical approaches, reconstruction protocols, and outcome definitions. The data are presented for descriptive contextual purposes only. No conclusions regarding equivalence or superiority can be drawn from this table. CSF, cerebrospinal fluid; LD, lumbar drainage; TachoSil, collagen sponge coated with human coagulation factors (fibrinogen/thrombin); BMI, body mass index; RT, radiotherapy; NSF, nasoseptal flap (vascularized); PSM, propensity score matching; GS, gelatin sponge; CM, collagen matrix; OC, oxidized cellulose; PDS, polydioxanone.; G (grade), Esposito-Kelly leak grade (0 = no leak, 1 = weeping, 2 = moderate, 3 = high-flow).