Arquivos de Neuro-Psiquiatria (Jul 2015)

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

  • Yasunori Fujimoto,
  • Leonardo Balsalobre,
  • Fábio P. Santos,
  • Eduardo Vellutini,
  • Aldo C. Stamm

DOI
https://doi.org/10.1590/0004-282X20150070
Journal volume & issue
Vol. 73, no. 7
pp. 611 – 615

Abstract

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Objective 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.Method 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.Results 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%).Conclusion 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.

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