Brain Tumor Res Treat.  2019 Apr;7(1):10-15. 10.14791/btrt.2019.7.e19.

Utilization of the Nasoseptal Flap for Repair of Cerebrospinal Fluid Leak after Endoscopic Endonasal Approach for Resection of Pituitary Tumors

• Kessler RA
• Garzon-Muvdi T
• Kim E
• Ramanathan M
• Lim M

• KMID: 2444790
• DOI: http://doi.org/10.14791/btrt.2019.7.e19

Abstract

BACKGROUND
One of the most frequent complications after endoscopic endonasal approach (EEA) for resection of pituitary tumors is cerebrospinal fluid (CSF) leaks. With the introduction of the pedicled nasoseptal flap, the reconstruction of the skull base has improved significantly resulting in a decrease in the occurrence of persistent CSF leaks. We present our experience utilizing the pedicled nasoseptal flap technique after EEA for reconstruction of the skull base in cases where CSF leak was detected.
METHODS
Data for patients undergoing EEA for pituitary tumors was retrospectively reviewed. These included demographic, clinical, operative, radiographic, and pathological information. Incidence of post-operative complications and CSF leaks were recorded. Descriptive statistical analysis was performed.
RESULTS
Between 2008 and 2015, 67 patients and 69 hospital admissions with pituitary tumors underwent a nasoseptal flap to reconstruct a skull base defect at Johns Hopkins Hospital. The mean age at surgery was 54.5±14.2 years. Fifty-two percent of patients were male. Forty-six percent of patients were white, 33% African-American, and 12% belonged to other racial groups. There was an intraoperative CSF leak in 39% of patients. Seventy percent of patients with an intraoperative CSF leak had a nasoseptal flap reconstruction of the skull base. There were zero postoperative CSF leaks.
CONCLUSION
With the introduction of the pedicled nasoseptal flap for reconstruction of the skull base after EEA for resection of pituitary adenomas, the incidence of postoperative CSF leaks has decreased significantly. In this retrospective analysis, we demonstrate the effectiveness of the use of nasoseptal flap in repairing CSF leak after EEA.

Keyword

Neoplasms; Neurosurgery; Skull base; Adenoma

MeSH Terms

Adenoma
Cerebrospinal Fluid Leak*
Cerebrospinal Fluid*
Humans
Incidence
Male
Neurosurgery
Pituitary Neoplasms*
Retrospective Studies
Skull Base

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