Simple dural closure using a knotless barbed suture in endoscopic transsphenoidal surgery: preliminary experience

Background: Several literatures reported that suturing dura was reliable in preventing cerebrospinal fluid (CSF) leak in transsphenoidal surgery. However, suturing and knotting is technically challenging and time consuming in the transsphenoidal approach.Objectives: To simplify the dural suturing procedure, a preliminary study of barbed suturing in endoscopic transsphenoidal surgery was introduced.Material and methods: We retrospectively reviewed the patients underwent dural closure using knotless suturing after endoscopic transsphenoidal surgery from August 2015 to September 2018. In the cases of no or low-flow CSF leak (Kelly's classification grade 0–2), the dura was sutured to restore anatomic structure and prevent postoperative CSF leak. In the cases of high-flow CSF leak (Kelly's classification grade 3), multilayered reconstruction including dural suturing was performed. The suturing time, intra- and postoperative CSF leak were recorded.Results: Thirty-three patients underwent dural barbed suturing. The mean suturing time was about 10 min. Intraoperative CSF leak was encountered in 16 patients, including 7 patients with grade 1 CSF leak, 5 patients with grade 2 CSF leak and 4 patients with grade 3 CSF leak. No one developed into postoperative CSF leak.Conclusion: Dural closure using a barbed suture is a simply and reliable technique.