Endoscopic repair of large dural defects in transsphenoidal surgery by suturing acellular dermal matrix graft with the dura: a technical note

OBJECTIVE: To introduce acellular dermal matrix (ADM) suturing as a novel repair method for intraoperative high-flow cerebrospinal fluid (CSF) leakage during transsphenoidal surgery (TSA), aiming to replace autologous fat/fascia lata grafts and reduce surgical morbidity. METHODS: Five patients (2 invasive pituitary adenomas, 2 craniopharyngiomas, 1 epidermoid cyst) underwent total sellar/suprasellar tumor resection and presented intraoperative high-flow CSF leakage. ADM grafts were tailored to dural defects and sutured directly to native dural edges. Outcomes included repair integrity, operative efficiency, and postoperative complications (CSF leakage, infection). RESULTS: All cases achieved dural closure without autologous tissue harvesting. Mean operative time was reduced by avoiding graft harvest procedures. No postoperative CSF leakage or intracranial infections occurred. At 30-day follow-up, all patients exhibited satisfactory recovery with stable skull base reconstruction. CONCLUSION: ADM suture repair eliminates donor-site morbidity and shortens operative time while providing robust dural sealing. This technique may be a promising alternative to conventional autologous grafts for high-flow CSF leakage management, warranting larger-scale validation.