Objective  The technique and the effect of sellar floor reconstruction in 449 patients with pituitary adenoma who underwent transsphenoidal surgery were retrospectively analyzed.

  Methods  A total of 449 patients received pituitary adenoma resection via the endonasal transsphenoidal approach (including 15 cases of endoscope-assisted surgery). Damage to the sellar diaphragm and leakage of the cerebrospinal fluid (CSF) occurred intraoperatively in 52 cases. The ventage of sellar diaphragm was packed with absorbable hemostatic cotton and gelatin sponge. Artificial dura mater and fibrin glue were then used to seal and to reconstruct the sellar floor. Post-operative CSF leakage in 6 cases and delayed CSF leakage occurred in 2 cases. To manage the CSF leakage, intranasal vaseline gauze was maintained in place; meanwhile continuous lumbar CSF drainage and mannitol were used to decrease the intracranial pressure.

  Results  The incidence of CSF leakage was 12% (52 cases) during the surgery and 1.3% (6 cases) after surgery. The incidence of delayed CSF leakage was 0.45% (2 cases). Retention of the intranasal vaseline gauze and reduction of intracranial pressure were effective for treating postoperative CSF leakage. Most cases were cured in one week, whereas only one patient was cured after 3 weeks. One patient had meningitis and recovered after symptomatic treatment.

  Conclusion  In transsphenoidal surgery for pituitary adenomas, accurate intrasellar packing and sellar floor reconstruction with artificial dura mater and fibrin glue effectively prevent postoperative CSF leakage.