The application of nasoseptal " rescue" flap technique in endoscopic transsphenoidal pituitary adenoma resection

Abstract

Objective To explore the reliability and superiority of nasoseptal flap technique in neuroendoscopic transnasal resection of pituitary adenoma. Methods A retrospective clinical analysis was conducted about 113 cases of endoscopic transsphenoidal pituitary adenoma resection with the application of nasoseptal flap technology in Department of Neurosurgery , Qilu Hospital of Shandong University from January 2016 to March 2017. The reliability and superiority of the technique were evaluated based on the duration of nasal cavity and sphenoid sinus stage, the incidence of post-operative anosmia and cerebrospinal rhinorrhea. Results The duration of nasal and sphenoid sinus stage was 15-30 minutes, averaging 24.0±4.5 minutes. There were 27 (23.9%) cases of intraoperative cerebrospinal fluid leakage including 24 cases of low flow cerebrospinal fluid leak and 3 cases of high flow cerebrospinal fluid leak. Twenty-three cases were converted from nasoseptal flap to nasal septum flap. The patients were followed up for 3-15 months, averaging 8.0±4.3 months. There were 17 cases(15.0%) of postoperative olfactory decline or disappearance, 1 case(0.9%) of epistaxis and 1 case(0.9%) of cerebrospinal rhinorrhea. Conclusions The application of nasoseptal flap technique could facilitate sellar floor reconstruction in case of intraoperative rupture of diaphragma sellae. There seems to be no increase of the duration of sphenoid sinus and nasal stage. Key words: Pituitary neoplasms; Natural orifice endoscopic surgery; Transphenoidal; Nasoseptal rescue flap; Nasal septum flap