Fat graft in cerebrospinal fluid leak repair after sellar and parasellar lesion surgery of 2000 patients; a multicenter study

Introduction: This study investigates the outcome of cerebrospinal fluid leakage repair after endoscopic trans -sphenoidal surgery (ETSS) sellar and parasellar lesions with fat graft.Method and materials: This is a cross-sectional study designed to evaluate the results of sellar and parasellar repair with simplified method of using only fat graft as the primary choice in patients undergoing ETSS surgery at three referral hospitals between 2011 and 2021.Results: In 2000 sellar and parasellar transsphenoidal surgeries, 860 patients had intraoperative CSF leak and were repaired to stop CSF leak mostly with fat graft only. 58 patients came back with delayed cerebrospinal fluid leak. Of these, 21 patients did not have intraoperative leak with no primary surgical repair but came back with a delayed CSF leak. Repair method for 37 're-leak' cases was fat in 29 patients, fat with fascia and/or nasoseptal flap for the rest of them. The success rate was 96.3% for intraoperative leaks that were primarily managed with fat graft alone.Conclusion: Our study suggests that fat graft can be considered a reliable material for sellar reconstruction which is easy to harvest and use, regardless of the type of leak flow (high vs low). Using other materials or more complex multilayer methods such as facial grafts or pedicled vascularized flaps are advisable choices for unusual and very large defects or secondary postoperative CSF leaks.