Novel harvesting technique of the nasoseptal flap in large sphenoidotomy undergoing revision with transsphenoidal approach.
OBJECTIVE
Blood supply to the nasoseptal flap (NSF) can be disrupted by large sphenoidotomies in an endonasal transsphenoidal approach (TSA). In such patients with recurrent sellar tumor, an NSF can be unavailable in the sellar reconstruction. Herein, we present a new harvesting method of the NSF in revision endonasal TSA, where injury to its vascular pedicle of the NSF by a large sphenoidotomy is highly suspected.


METHODS
Data for patients with large sphenoidotomy who underwent revision endonasal TSA and NSF at Chonnam National University Hwasun Hospital were collected consecutively from January 2010 to July 2011. A retrospective review of these cases was performed.


RESULTS
Seven patients with a previous large sphenoidotomy requiring revision TSA underwent a new modification technique of the NSF. Pathologies included 6 pituitary adenomas and 1 craniopharyngioma. All patients had intraoperative cerebrospinal fluid (CSF) leak, necessitating multilayered sellar reconstruction, including NSF. No patients had flap necrosis, and closure of CSF leak was possible in 6 of 7 patients. Delayed CSF leak in a patient was due to the migration of the flap over the defect, and no septal complications such as septal perforation and saddle nose were noted.


CONCLUSIONS
Our harvesting technique of the NSF in patients with recurrent sellar tumors is reliable for sellar reconstruction where the NSF may be unavailable because of previous large sphenoidotomy. This novel technique has an excellent success rate in flap viability and minimal additional endonasal morbidity.
Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, South Korea.
Dong Hoon
DH
Lee
Tae Mi
TM
Yoon
Joon Kyoo
JK
Lee
Woo Youl
WY
Jang
Kyung Sub
KS
Moon
Shin
S
Jung
Young Eun
YE
Joo
Sang Chul
SC
Lim
D000328:Adult; D000368:Aged; D002559:Cerebrospinal Fluid Rhinorrhea / Q000601:surgery; D003397:Craniopharyngioma / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013100:Sphenoid Bone / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome