Use of equine pericardium sheet (LYOMESH®) as dura mater substitute in endoscopic endonasal transsphenoidal surgery

Abstract

Objective: The aim of this study was to describe the use of equine pericardium sheet (Lyomesh (®) ) as dural substitute for sellar reconstruction after endoscopic endonasal transsphenoidal surgery for the removal of pituitary adenomas.

Methods: We reviewed data of patients that underwent surgery by means of an endoscopic endonasal transsphenoidal approach for the removal of pituitary adenomas over a 12-months period, starting in May 2012, i.e. when we adopted Lyomesh (®) (Audio Technologies, Piacenza, Italy) an equine pericardium sheet, as dura mater substitute.

Results: During the 12-months period evaluated, we performed an endoscopic endonasal transsphenoidal operation for a variety of pituitary lesions on 102 consecutive patients. Among these, in 12 patients (9.4%) harboring a pituitary adenoma, the implant of the pericardium sheet was used. Four patients (33.3%) presented a small intraoperative cerebrospinal fluid (CSF) leak; in these cases the Lyomesh (®) was placed intradurally with fibrin glue and, thereafter, several layers were positioned in extradural space. In 8 other subjects without any evidence of CSF leak, the dural substitute was placed intradurally and fibrin glue was injected intradurally to hold the material in place.

Conclusions: Even if based on a relatively small patient series, our experience demonstrated that the use of equine pericardium sheet (Lyomesh (®) ) as dura mater substitute in transsphenoidal surgery is safe and biocompatible, as compared with other dural substitutes.

Keywords: CSF leak; Dural Substitutes; Endoscopic Endonasal Surgery; Skull Base Reconstruction.

Fig 1

a: Intraoperative image showing a thinned suprasellar cistern descending into the sellar cavity after the removal of a pituitary adenoma; b: a pericardium sheet was used to protect and enforce the suprasellar cistern and prevent its postoperative rupture and consequent CSF leak; c, d: multiple layers of dural substitute placed in extradural space to close the sellar floor *: single layer of Lyomesh® placed intradurally, over the Suprasellar Cistern; **: Lyomesh® placed extradurally; SC: suprasellar cistern.

Fig 2

Preoperative and postoperative sellar MRi of a patient with an intra-suprasellar non-functioning pituitary adenoma, who received the implant of Lyomesh ^® . Preoprative (a) coronal and (b) sagittal scans. Postoperative (c) coronal and (d) sagittal scans showing no direct or indirect sign of complications related with the presence of Lyomesh ^® .