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J Neurol Surg B Skull Base 2021; 82(03): 313-320
DOI: 10.1055/s-0039-3400224
Original Article

Study on Closure of Skull Base Defect Post–Endoscopic Endonasal Transsphenoid Pituitary Surgery: A Novel Flap Design

Gokul Gopi 
1   All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Saurav Sarkar
2   Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Sudipta Mohakud
3   Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Ashis Patnaik
4   Department of Neurosurgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Sumit Bansal
4   Department of Neurosurgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
C. Preetam
2   Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Rabi Narayan Sahu
4   Department of Neurosurgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Pradipta Ku Parida
2   Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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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


Publication History

Received: 10 June 2019

Accepted: 28 September 2019

Article published online:
14 November 2019

© 2019. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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