Sellar Floor Reconstruction with Concha Bullosa Autograft and Nasal Septal Flap

Objective: To describe a reliable, easy method for sellar floor reconstruction following expanded endoscopic endonasal transsphenoidal surgery utilizing concha bullosa (pneumatized middle turbinate) bone autograft and nasal septal mucoperichondrium flaps.

Clinical Presentation: A 62-year-old woman presented with the insidious onset of enlarging hands and feet, coarsening of facial features, and bilateral carpal tunnel syndrome. Endocrine studies revealed an elevated growth hormone (22 ng/mL) and somatomedin-C (810 ng/mL) and brain MRI demonstrated a 1.2-cm pituitary adenoma.

Intervention: The patient was diagnosed with acromegaly secondary to a pituitary adenoma and underwent expanded endoscopic endonasal transsphenoidal surgery for tumor resection. Preoperatively, the patient was noted to have right middle turbinate pneumatization (concha bullosa). Following adenoma resection, the sellar floor was reconstructed utilizing concha bullosa bone autograft and bilateral septal mucoperichondrium flaps.

Conclusion: Conca bullosa, a thin concave shaped bone, and nasal septal flaps of mucoperichondrium, provide an optimal substrate fit and vascularized tissue for sellar reconstruction.