Abstract
To explore the reliability and superiority of nasoseptal “rescue” flaptechnique in neuroendoscopic transnasal pituitary adenoma resection. Retrospectiveclinical analysis of 113 cases of endoscopic transsphenoid pituitary adenomaresection with the application of nasoseptal “rescue” flap technology. Thereliability and the superiority of the technique were evaluated according to theduration of nasal cavity and sphenoid sinus stage, the incidence of postoperativeanosmia, and cerebrospinal rhinorrhea. The duration of nasal and sphenoid sinusstage was 15–30 min, averaging 24 min. There were 27 cases of intro-operativecerebrospinal fluid leakage, including 24 cases of low-flow cerebrospinal fluid leakand 3 cases of high-flow cerebrospinal fluid leak. Twenty-three cases were convertedfrom nasoseptal “rescue” flap to nasal septum flap. There were 17 cases ofpostoperative olfactory decline or disappearance, 1 case of epistaxis and 1 case ofcerebrospinal rhinorrhea. The application of nasoseptal “rescue” flap technique canproceed sellar floor reconstruction when the diaphragma sellae rupture occurs duringthe operation. There is no obvious increase of the duration of sphenoid sinus andnasal stage and the rate of postoperative olfactory loss. This technique can be usedas a conventional technique for endoscopic transsphenoid pituitary adenomaresection.
Highlights
Cerebrospinal fluid rhinorrhea is one of the most common complications of surgical treatment of pituitary adenoma under neuroendoscope
Twenty-three cases were converted from nasoseptal “rescue” flap to nasal septum flap as there was CSF fistula occurred during the operation in these patients
Surgeons used to apply autologous fat to fill in the leak, and covered with fascia lata. This flap could not be converted without compromising the blood supply, which may lead to postoperative local transplantation of fascia necrosis or absorption, resulting in failure of repair and cerebrospinal fluid nasal fistula, and this method requires a separate incision in the thigh or abdomen, aggravating the trauma and psychological burden of the patient
Summary
Cerebrospinal fluid rhinorrhea is one of the most common complications of surgical treatment of pituitary adenoma under neuroendoscope. The incidence of this complication was greatly reduced by using the technique of pedicled nasoseptal flap (usually originated from mucoperiosteum and mucoperichondrium of the nasal septum), which established the technical foundation for the reconstruction of the skull base for the neuroendoscopic surgery [1, 2]. The commonly used methods in the treatment of sphenoid sinus mucosa cannot effectively transfer to the nasal septum mucosa
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