Cubism Graft, in Multilayer Sellar Repair: A Novel Technique

Abstract

Background: The endoscopic endo-nasal transsphenoidal approach is the best option for the surgical excision of tumors of pituitary. Cubism is a double-layer graft that is made by combining septal cartilaginous dust with platelet-rich fibrin to create a very thin graft. This study intended to determine the effectiveness of cubism graft in reconstructing the sellar region following endoscopic endonasal removal of pituitary tumors. Thirty-four people who had recurrent pituitary tumours were included in this retrospective pilot study. A thorough clinical examination, laboratory investigations, and history were administered to all patients, and imaging studies as computed tomography scan and magnetic resonance imaging.  The cases were followed up on every three months up to one year.

Results: The operative time ranged from 2.0 to 2.5 hours with a mean of 2.15±0.85 hours, Blood loss range was from 150 to 300 ml with a mean of 225±10.65 ml, 27 (79.4%) patients had total surgical resection and 7 (20.6%) patients had subtotal surgical resection, 18 (52.9%) had visual improvement. Regarding complications, 4 (11.8%) patients had diabetes insipidus, and 1 (2.9%) patient had acute coronary syndrome. No patients had any cerebrospinal fluid (CSF) leak. There was a significant relation between complications and age, while there was insignificant relation between complications and sex, functioning tumour and surgical resection.

Conclusions: Cubism graft is a material that is both reliable and readily harvested, and it has a high success rate for primary repairs of sellar floor. They can be used as a further technique in the treatment of subsequent or complicated surgical CSF leakage.