Abstract
Objective This study was aimed to compare the closure of skull base defect in endoscopic endonasal
transsphenoid surgery of pituitary tumors, using bipedicled nasal septal flap versus
fascial closure. The study hypothesis being that bipedicled nasal septal flap is better,
compared with fascial closure of skull base defect post–endoscopic endonasal transsphenoid
surgery of pituitary tumors.
Methods All the eligible patients were randomly divided into two groups and then randomly
allocated to the surgeons. In one group, fat and fascia lata was used for closure
of the skull base defect and nasal septal flap was not harvested whereas in the other,
nasal septal flap was used for closure.
Results There was a statistically significant difference in postoperative cerebrospinal fluid
leak between the two groups. Patients who had undergone flap repair had lower incidence
of postoperative cerebrospinal fluid (CSF) leak. Duration of postoperative hospital
stay was also less among the group who underwent flap repair (statistically significant).
Conclusion Bipedicled nasal septal flap serves an excellent cover for the skull base defect
following endoscopic endonasal transsphenoidal pituitary surgery. It can prevent postoperative
CSF leak even in cases where tissue glue is not used.
Keywords
skull base - transsphenoid surgery - septal mucosal flap - flap repair - pituitary
tumors
