Chronic rhinosinusitis due to cyano-acrylic glue after endoscopic transsphenoidal pituitary surgery
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CASE REPORT
Open Access
Chronic rhinosinusitis due to cyano-acrylic glue after endoscopic transsphenoidal pituitary surgery Majid Bani-Ata1*, Firas Alzoubi2, Bashar Abuzayed3, Ala”a A. Alhowary4 and Abdelwahab J. Aleshawi5
Abstract Background: To reduce the risk of cerebrospinal fluid leak, clinicians utilize a filling material placed in the sella followed by floor reconstruction with various materials, including glue sealing. Cyano-acrylic glue Glubran®2 glue is commercially available and is generally used as embolizing agent and for the prevention of cerebrospinal fluid leakage. Case Description: A 25-year-old woman underwent endoscopic endonasal transsphenoidal surgery for pituitary adenoma. After tumor resection, sellar floor reconstruction was performed by mucosal graft and Glubran®2 glue. The early post-operative period was uneventful. However, 2 months after surgery, the patient complained of headache, facial pain and greenish foul-smelling nasal discharge with solid particles dripping from the nose. Medical treatment was unsuccessful. Brain MRI showed inflammation and thickening of the sphenoidal and parasphenoidal mucosa. The patient underwent endoscopic endonasal surgery and a solid glass-like mass surrounded by inflamed infected mucosa was seen in the inferior and lateral aspects of the sphenoid sinus. Efforts were made to erupt and de-crust the solid mass until total resection was achieved. Early post-operative period was uneventful, and a course of antibiotics was continued until total disappearance of the discharge. Conclusion: To the best of our knowledge, this is the first case reporting of acrylic glue (Glubran®2)-related sinusitis. Surgeon should be aware about similar side effects for the glue material that would complicate the surgery. Keywords: Acrylic glue, Transsphenoidal approach, Chronic rhinosinusitis
Background Cerebrospinal fluid (CSF) leaks are considered serious complications in transsphenoidal pituitary surgery and efficient tissue sealing is an important preventive measure. For reducing the risk of CSF leaks, clinicians have attempted various methods of sellar reconstruction. These typically utilize a filling material (i.e., fat, collagen sponge) placed in the sella followed by floor reconstruction with various materials, including glue sealing [1]. * Correspondence: [email protected] 1 Department of Special Surgery, Division of Otolaryngology, Faculty of Medicine, Jordan University of Science and Technology, P.O.Box: 3030, Irbid 22110, Jordan Full list of author information is available at the end of the article
Cyano-acrylic glue Glubran®2 glue (GEM Srl, Viareggio, Italy) is commercially available and is generally used as a fixative for injured tissue, for hemostasis, as embolizing agent and for the prevention of CSF leakage [2–4]. We have been using this agent routinely in duroplasty after transsphenoidal pituitary surgery for the past 5 years, without any recorded glue-related complications. In this report, we present an unusual case of cyano-acrylic glueinduced chronic
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