Introduction: Introduction. Abdominal fat grafts are often harvested for use in skull base reconstruction and cerebrospinal fluid (CSF) leak repairs, and for operations traversing the nasal sinuses or mastoid bone. While the endoscopic transnasal approach is considered “scarless” brain surgery, the traditional abdominal fat graft harvest can still result in a disfiguring scar across the abdomen.

Methods: Methods. The authors present a scarless intra-umbilical fat graft technique used in four patients undergoing an endoscopic transsphenoidal/transplanum resection of a pituitary adenoma. Careful circumferential fat dissection at the umbilicus, with progressive retraction of the graft, was crucial to ensure maximal visualization, and to prevent injury to the subcutaneous vessels and rectus fascia. Avoidance of the anterior abdominal skin prevented visible injury.

Results: Results. Following reconstruction of the sellar skull base, all patients did well post-operatively with no evidence of CSF leak. The small size of the umbilical incision, and post-resection tamponade with sponge packing, resulted in excellent hemostasis. At 12-week follow-up, there was no evidence of a scar, intra-cavity hematoma, or wound infection.

Conclusions: Conclusions. Fat graft harvest through an intra-umbilical incision can result in a scarless abdominal harvest without hematoma or wound infection, and may be a useful procedural adjunct for “scarless” brain surgery.

Patient Care: The technique presented here represents an attractive, safe, and scar-free alternative for abdominal fat graft harvest to the traditional, less cosmetic alternative.

Learning Objectives: Learning Objectives. By the conclusion of this session, participants should be able to: 1) Describe the importance of surgical harvest technique for reducing infection, scar formation, and hematoma at the abdominal fat graft site. 2) Discuss, in small groups, strategies to limit complications at fat graft harvest site. 3) Identify an effective technique to reduce injury to subcutaneous vessels and unnecessary damage to the rectus fascia during abdominal fat graft harvest.

References: References: 1. Cook SW, Smith Z, Kelly DF. Endonasal transsphenoidal removal of tubercullum sellae meningiomas: technical note. Neurosurgery Jul; 55(1): 239-44, 2004. 2. Guyuron B, Majzoub RK. Facial augmentation with core fat graft: a preliminary report. Plast Reconstr Surg Jul; 120(1): 295-302, 2007. 3. Kassam A, Carrau RL, Snyderman CH, Gardner P, Mintz A. Evolution of reconstructive techniques following endoscopic expanded endonasal approaches. Neurosurg Focus 19(1):E8, 2005. 4. Snyderman CH, Kassam AB, Carrau R, Mintz A. Endoscopic reconstruction of cranial base defects following endonasal skull base surgery. Skull Base 17(1):73-8, 2007. 5. White DR, Dubin MG, Senior BA. Endoscopic repair of cerebrospinal fluid leaks after neurosurgical procedures. Am J Otolaryngol Jul-Aug; 24(4): 213-6, 2003.