Sellar reconstruction after pituitary adenoma resection

Postoperative cerebrospinal fluid (CSF) leak remains the most common serious complication of endoscopic hypophysectomy. To reduce this complication rate, it is essential to choose the optimal reconstruction method. Issues to be addressed when discussing sellar reconstruction after pituitary adenoma resection include the following: Is sellar reconstruction always necessary after pituitary adenoma resection (even when there has been no intraoperative CSF leak)? If reconstruction is mandated, how do we choose the materials and method of reconstruction? How do patient, tumor, and surgeon factors influence these decisions? To answer such questions, one has to take into consideration the size of the pituitary adenoma, its suprasellar extension and extension beyond the diaphragma sella, and the type of CSF leak (low or high flow), as well as patient- and surgeon-related factors. This chapter discusses the relevant evidence and presents our algorithm in dealing with sellar reconstruction after pituitary adenoma resection.