Free Middle Turbinate Mucosal Graft Reconstruction after Endonasal Pituitary Surgery: Minimizing CSF Leak and Sinonasal Morbidity without Pedicled Flaps

Abstract

Objective: To demonstrate that free middle turbinate (FMT) graft reconstruction after endoscopic, endonasal pituitary surgery is a robust repair, not requiring additional incisions or lumbar drain that has minimal sinonasal morbidity. Study Design: A consecutive, prospective case series of a single surgeon's endoscopic, endonasal pituitary surgery using a novel reconstructive method. Patients/material and Methods: Endoscopic, endonasal pituitary surgery was performed by the senior author (C. Hayhurst) in a standardized manner: the right middle turbinate was removed, the pituitary tumor resected and an FMT graft used for the reconstruction. CSF leak rates and SNOT-22 scores at 6 weeks and 6 months postsurgery were recorded. Results: Overall 32 adult patients were included in the study (19F, 13M). There were 9 functioning microadenomas and 23 macroadenomas. The mean tumor volume in the macroadenoma group was 6.45 mL (range 1.16-31.72). The rate of gross-total resection confirmed on postoperative MR was 87.5%. There were three intraoperative, but no postoperative CSF leaks. The median post-op stay was 2 days. The mean SNOT-22 score was 31.9 at 6 weeks and 23.4 at 6 months. The mean scores of the nasal component of the SNOT-22 scores were 8.13 at 6 weeks and 3.81 at 6 months—a “normal “score is <3.03. Conclusions: Reconstruction with an FMT graft in endonasal, endoscopic pituitary surgery provides a robust repair, allows for early patient discharge and causes minimal rhinological morbidity at 6 months.