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Sellar Defect Reconstruction with Vascularized Superior Turbinate Mucosal Flaps in Endonasal Endoscopic Transsellar Approach
- Source :
- World Neurosurgery. 133:e503-e512
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- Background The pedicled nasoseptal flap (NSF) constitutes the primary reconstructive option for most skull base defects in endonasal endoscopic approaches. The superior nasal turbinate (ST) has received little attention. We report our preliminary experience with the use of the ST mucosal flap in selected cases. Methods We performed a retrospective review of patients who underwent endonasal endoscopic approaches and identified 9 patients who were reconstructed with vascularized ST mucosal flaps as part of a double-layer or triple-layer reconstruction. When there was no intraoperative cerebrospinal fluid (CSF) leak, we used a double-layer technique. If there was an intraoperative CSF leak, regardless of the quality of leakage, we preferred a triple-layer repair technique. In patients with high-flow leaks, triple-layer repair was performed using only autologous tissue grafts and flaps. Results Intraoperative CSF leaks were noted in 7 of 9 patients. Among them, 4 patients had low-flow CSF leaks (grade 1 and 2) and 3 patients had high-flow CSF leaks (grade 3). All reconstructions had complete defect coverage with the ST flaps and NSFs were preserved. All the flaps were viable at 4 weeks without a CSF leak or complication at the reconstruction site. There was no contraction or partial loss of the flap. After a mean follow-up period of 9 months, none of the patients required a flap revision, developed a mucocele, infection, or other complication. Conclusions An ST flap can be used for the vascularized reconstruction of sellar defects if it is bilaterally available. This option should not be overlooked and wasted.
- Subjects :
- Adult
Male
Natural Orifice Endoscopic Surgery
medicine.medical_specialty
Leak
Superior turbinate
Cerebrospinal Fluid Rhinorrhea
Nose
Autologous tissue
Surgical Flaps
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Cerebrospinal fluid
medicine
Humans
Mucocele
Aged
Retrospective Studies
Skull Base
business.industry
Defect reconstruction
Middle Aged
Plastic Surgery Procedures
medicine.disease
Surgery
Nasal Mucosa
Skull
medicine.anatomical_structure
030220 oncology & carcinogenesis
Neuroendoscopy
Female
Neurology (clinical)
business
Complication
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 18788750
- Volume :
- 133
- Database :
- OpenAIRE
- Journal :
- World Neurosurgery
- Accession number :
- edsair.doi.dedup.....b8b2e19812bb124cdda58879de7ac5ce