Endoscopic combined "transseptal/transnasal" approach for pituitary adenoma: reconstruction of skull base using pedicled nasoseptal flap in 91 consecutive cases

• Published in: Arquivos de neuro-psiquiatria 2015-07, Vol.73 (7), p.611-615
• Main Authors: Fujimoto, Yasunori, Balsalobre, Leonardo, Santos, Fábio P, Vellutini, Eduardo, Stamm, Aldo C
• Format: Article
• Language: English
• Subjects: acesso endoscópico endonasal; Adenoma - surgery; adenoma de hipófise; Adult; Aged; Aged, 80 and over; Cerebrospinal Fluid Leak - etiology; Cerebrospinal Fluid Leak - prevention & control; Female; Fistula - etiology; Fistula - prevention & control; flap naso-septal pediculado; fístulas líquido cefalorraquidiano; Humans; Male; Middle Aged; Nasal Cavity - surgery; Nasal Septum - surgery; Natural Orifice Endoscopic Surgery - adverse effects; Natural Orifice Endoscopic Surgery - methods; NEUROSCIENCES; Pituitary Neoplasms - surgery; Postoperative Complications - prevention & control; PSYCHIATRY; Reconstructive Surgical Procedures - methods; Reproducibility of Results; Retrospective Studies; Risk Factors; Skull Base - surgery; Surgical Flaps - surgery; Time Factors; Treatment Outcome; Young Adult
• ISSN: 0004-282X; 1678-4227; 1678-4227; 0004-282X
• DOI: 10.1590/0004-282X20150070

The purpose of this study was to describe the endoscopic combined "transseptal/transnasal" approach with a pedicled nasoseptal flap for pituitary adenoma and skull base reconstruction, especially with respect to cerebrospinal fluid (CSF) fistula. Ninety-one consecutive patients with pituitary adenomas were retrospectively reviewed. All patients underwent the endoscopic combined "transseptal/transnasal" approach by the single team including the otorhinolaryngologists and neurosurgeons. Postoperative complications related to the flap were analyzed. Intra- and postoperative CSF fistulae were observed in 36 (40%) and 4 (4.4%) patients, respectively. Among the 4 patients, lumbar drainage and bed rest healed the CSF fistula in 3 patients and reoperation for revision was necessary in one patient. Other flap-related complications included nasal bleeding in 3 patients (3.3%). The endoscopic combined "transseptal/transnasal" approach is most suitable for a two-surgeon technique and a pedicled nasoseptal flap is a reliable technique for preventing postoperative CSF fistula in pituitary surgery.