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J Neurol Surg B Skull Base
DOI: 10.1055/a-2717-2780
Original Article

Sinonasal and Skull Base Morbidity from a Modified Nasoseptal Flap versus No Flap in Pituitary Surgery

Autoren

  • Ash Li Khoo

    1   Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, New South Wales, Australia
    2   Southwest Sydney Clinical School, University of New South Wales, Sydney, Australia

  • Kachorn Seresirikachorn 

    1   Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, New South Wales, Australia
    3   Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
    4   Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
    5   Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia

  • Gretchen M. Oakley

    6   Division of Otolaryngology – Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, United States

  • Henry P. Barham

    7   Rhinology and Skull Base Research Group, Baton Rouge General Medical Center, Baton Rouge, Louisiana, United States
    8   Sinus and Nasal Specialists of Louisiana, Baton Rouge, Louisiana, United States

  • Jessica W. Grayson 

    9   Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States

  • Carolyn Orgain 

    10   Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, Vermont, United States

  • Raquel Alvarado

    1   Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, New South Wales, Australia
    11   School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia

  • João Mangussi-Gomes 

    1   Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, New South Wales, Australia

  • Larry H. Kalish

    1   Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, New South Wales, Australia
    12   Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, University of Sydney, Sydney, New South Wales, Australia
    13   Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia

  • Raewyn G. Campbell

    1   Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, New South Wales, Australia
    5   Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
    14   Department of Otolaryngology, Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia

  • Richard J. Harvey

    1   Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, New South Wales, Australia
    5   Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
    11   School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia

Funding Information This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Abstract

Background

Durable sellar reconstruction and preserving sinonasal function are pivotal objectives in endoscopic pituitary surgery.

Objective

This study aimed to investigate the postoperative skull base and sinonasal morbidity associated with a modified nasoseptal flap (NSF) in endoscopic pituitary surgery.

Methods

A retrospective cohort study was conducted on patients undergoing endoscopic transsphenoidal pituitary surgery with either an NSF or non-NSF reconstruction of the sella. Patients had an obvious or suspected intraoperative cerebrospinal leak. A minimum 6-month follow-up was required. Outcome measures included postoperative skull base morbidity (cerebrospinal fluid leak, flap necrosis, pneumocephalus, meningitis, other intracranial infections, intracranial hemorrhage), sinonasal morbidity (epistaxis, crusting, sinus infection, atrophic rhinitis, persistent crusting, sinus dysfunction, mucocele formation, septal perforation), and patient-reported outcome measures (Sinonasal Outcome Test 22 [SNOT22; range 0–110], Nasal Symptom Score [NSS; range 0–30], and olfactory dysfunction score [range 0–5]).

Results

About 372 patients (age 53.8 ± 16.7 years, 53.5% female) were included. Most patients underwent NSF reconstruction (87.1%). There was no significant difference in skull base morbidity between the NSF and non-pedicle flap groups. The NSF group had fewer self-reported sinus infections (0.9% vs. 6.4%, p = 0.03) and sinus dysfunction (2.8% vs. 31.3%, p < 0.01). Postoperative SNOT22 (12.9 ± 15.3 vs. 25.2 ± 21.3, p < 0.01), NSSs (2.3 ± 3.5 vs. 5.9 ± 6.0, p < 0.01), and olfactory dysfunction score (percentage of cases ≥“moderate problem [score 3],” 6.4% vs. 26.3%, p = 0.01) were also lower in the NSF group.

Conclusion

Utilizing a modified NSF in endoscopic transsphenoidal pituitary surgery allows for a sellar reconstruction option without detrimental impact on sinonasal function.

Keywords

morbidity - nasoseptal flap - pituitary surgery - sinonasal - skull base


Publikationsverlauf

Eingereicht: 22. März 2025

Angenommen: 05. Oktober 2025

Accepted Manuscript online:
07. Oktober 2025

Artikel online veröffentlicht:
14. Oktober 2025

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