World neurosurgery
September 15, 2026 · via Europe PMC
Endonasal Diaphragmatic Suturing for Restoration of Native Anatomical Layers: Technical Note.
Goto Y, Oshima M, Jibiki Y, Ikehata K, Tabata S, Imasato D, Shin M.
AI summary — for doctors, generated from the abstract only
A technical report describes a surgical technique of directly suturing a specific membrane (the diaphragma sellae) during endoscopic pituitary surgery, which successfully stopped high-flow cerebrospinal fluid leaks in all 4 patients where it was used, without complications.
What was studied
A technical note with video demonstration describing a surgical technique of direct suturing of the diaphragma sellae to immediately reconstruct the arachnoid barrier and control high-flow intraoperative cerebrospinal fluid (CSF) leakage during endoscopic transsphenoidal pituitary tumor surgery, illustrated by one representative case and a consecutive series of 4 total patients who underwent the technique.
Key findings
- In the representative case, diaphragmatic suturing successfully stopped high-flow CSF leakage during tumor removal, enabling secure reconstruction and uneventful recovery.
- In all 4 patients who underwent this technique, intraoperative CSF leakage resolved immediately after suturing, without deterioration of pituitary hormone function or additional complications.
- Gross-total tumor resection was consistently achieved in all 4 cases, and no postoperative CSF leakage occurred after multilayered reconstruction combined with this suturing technique.
Clinical relevance
The findings suggest that direct suturing of the diaphragma sellae may offer a reliable, anatomically sound way to manage challenging high-flow CSF leaks during pituitary surgery, potentially reducing the need for more extensive reconstructive techniques (such as large nasoseptal flaps) or prolonged lumbar drains, though based on a very small number of cases.
Who should care
Limitations
This is a technical note based on only 4 patients without a comparison group using alternative reconstruction techniques, so the comparative benefit of this specific suturing method cannot be established from this report alone.
Direct suturing of the diaphragma sellae successfully controlled high-flow CSF leaks during pituitary surgery in all 4 patients where it was used, suggesting a useful technique for this challenging surgical problem, pending confirmation in larger series.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Preventing postoperative cerebrospinal fluid (CSF) leakage in the presence of high-flow intraoperative leakage remains one of the most challenging issues in endoscopic transsphenoidal surgery (ETS), even when multilayered skull base reconstruction is performed1-5. Recent reports on dural suturing in ETS have revealed the importance of restoring native anatomical barriers, demonstrating very low postoperative leakage rates when primary closure is achieved6-11. Based on this concept, we applied direct suturing of the diaphragma sellae to immediately reconstruct the perforated arachnoid barrier and obtain real-time control of intraoperative CSF leakage12. In this video, we present a representative case in which diaphragmatic suturing successfully stopped high-flow leakage during tumor removal, enabling secure reconstruction and uneventful postoperative recovery. We further describe a consecutive series of four patients who underwent this technique; in all cases, intraoperative leakage resolved immediately after suturing, without deterioration of pituitary function or additional complications. Gross total resection was consistently achieved, and postoperative courses were favorable. In all four cases, multilayered reconstruction was performed, and no postoperative CSF leakage occurred. Direct diaphragmatic suturing offers an anatomically reasonable and rapid method for managing high-flow intraoperative CSF leakage, providing a valuable strategic option when conventional reconstruction alone is insufficient. This approach may result in postoperative patient comfort and recovery by enabling reliable intraoperative control of CSF leakage and reducing dependence on extensive nasoseptal flaps, or prolonged lumbar drainage.
Preventing postoperative cerebrospinal fluid (CSF) leakage in the presence of high-flow intraoperative leakage remains one of the most challenging issues in endoscopic transsphenoidal surgery (ETS), even when multilayered skull base reconstruction is performed1-5. Recent reports on dural suturing in ETS have revealed the importance of restoring native anatomical barriers, demonstrating very low postoperative leakage rates when primary closure is achieved6-11. Based on this concept, we applied direct suturing of the diaphragma sellae to immediately reconstruct the perforated arachnoid barrier and obtain real-time control of intraoperative CSF leakage12. In this video, we present a representative case in which diaphragmatic suturing successfully stopped high-flow leakage during tumor removal, enabling secure reconstruction and uneventful postoperative recovery. We further describe a consecutive series of four patients who underwent this technique; in all cases, intraoperative leakage resolved immediately after suturing, without deterioration of pituitary function or additional complications. Gross total resection was consistently achieved, and postoperative courses were favorable. In all four cases, multilayered reconstruction was performed, and no postoperative CSF leakage occurred. Direct diaphragmatic suturing offers an anatomically reasonable and rapid method for managing high-flow intraoperative CSF leakage, providing a valuable strategic option when conventional reconstruction alone is insufficient. This approach may result in postoperative patient comfort and recovery by enabling reliable intraoperative control of CSF leakage and reducing dependence on extensive nasoseptal flaps, or prolonged lumbar drainage.
DOI
10.1016/j.wneu.2026.125322
PMID
42744232
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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