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Numerous reconstruction techniques have been proposed, but none has been established as the gold standard. To address this issue, we standardized rigid sellar floor reconstruction using a hard buttress, based on the concept of counteracting the water-hammer effect of pulsatile CSF pressure. We retrospectively analyzed 1,168 consecutive TSS procedures for sellar lesions performed by a single surgeon between October 2004 and March 2024. Routine rigid reconstruction was implemented from January 2009 (Group B,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009856) and compared with an earlier cohort without routine buttressing (Group A,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009312). Reconstruction materials included autologous bone grafts, calcium phosphate cement, titanium mesh, and resorbable plates. Rigid reconstruction was performed in 885 cases, most commonly with autologous bone (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009781), which proved most reliable. Calcium phosphate cement occasionally caused inflammatory change or graft dislodgement, and titanium mesh complicated reoperations. Postoperative CSF leakage requiring reoperation was significantly reduced from 2.88% in Group A to 0.47% in Group B (\n                    <jats:italic>P<\/jats:italic>\n                    = 0.002), despite a higher intraoperative leak rate in Group B (76.5% vs. 54.2%,\n                    <jats:italic>P<\/jats:italic>\n                    &lt; 0.0001), particularly grade 3 leaks (30.4% vs. 11.2%,\n                    <jats:italic>P<\/jats:italic>\n                    &lt; 0.0001). All postoperative leaks in Group B were attributable to inadequate buttressing. Rigid sellar floor reconstruction is a fundamental strategy\u2014together with dural suturing and vascularized mucosal flaps\u2014for safer and more extensive resections in modern TSS, supported by a physiological rationale based on the water-hammer effect.\n                  <\/jats:p>","DOI":"10.1007\/s10143-026-04408-5","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T06:40:48Z","timestamp":1784270448000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rigid sellar floor reconstruction in transsphenoidal surgery: prevention of cerebrospinal fluid leakage attributable to the water-hammer effect"],"prefix":"10.1007","volume":"49","author":[{"given":"Kosaku","family":"Amano","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuichi","family":"Oda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takakazu","family":"Kawamata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"4408_CR1","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1097\/00006123-199702000-00001","volume":"40","author":"I Ciric","year":"1997","unstructured":"Ciric I, Ragin A, Baumgartner C, Pierce D (1997) Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. 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Approval was granted by the ethics committee of the Tokyo Women\u2019s Medical University (approval number: 2021-0063). Given the retrospective design, the institutional review board waived the requirement for obtaining informed consent from the patients. We used the opt-out method. To protect patient privacy, we removed all identifiers from our records upon completion of our analyses.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have nothing to disclose.","order":3,"name":"Ethics","label":"Disclosures","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"480"}}