title: Challenges and surgical nuances in reconstruction of large planum sphenoidale tuberculum sellae defects after endoscopic endonasal resection of parasellar skull base tumors.
abstract: OBJECTIVE
  Endoscopic endonasal transplanum transtuberculum (EETT) resection of parasellar skull base (SB) tumors often results in large SB defects with intraoperative high-flow cerebrospinal fluid (CSF) leaks. Reconstruction of these defects can be challenging because of the large defects size, communication with the suprasellar cistern, and close proximity to the optic nerves and chiasm. Recent studies have postulated that transplanum defects may be associated with increased postoperative CSF leakage. We review our experience with reconstruction of transplanum defects after EETT resection of parasellar SB tumors. Challenges encountered during these repairs and our operative nuances for successful reconstruction are discussed.
  
  
  METHODS
  A retrospective analysis was performed between March 2010 and February 2012 on patients undergoing reconstruction of transplanum defects after EETT resection of parasellar SB tumors. Repair materials, defect sizes, postoperative CSF leakage, postoperative CSF diversion, and demographic data were collected.
  
  
  RESULTS
  Nineteen patients who underwent 22 repairs with a pedicled nasoseptal flap (PNSF) were identified. The mean age was 47.6 years (range, 12-68 years). Average defect size was 5.6 cm(2) (range, 2.2-10.4 cm(2)). Three failed repairs necessitated a revision procedure. All three revisions were successfully reconstructed with the previously used PNSF. The mean follow-up period was 13.5 months (range, 1-26 months). The overall success rate was 86.4% for transplanum defects alone, as compared to 97.0% for our comprehensive PNSF experience in 99 repairs.
  
  
  CONCLUSIONS
  Repair of large transplanum defects after EETT resection of parasellar SB tumors presents a unique challenge. Using a PNSF along with meticulous multilayer closure may help decrease postoperative CSF leaks.
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, University of Medicine and Dentistry of New Jersey - New Jersey Medical School, Newark, New Jersey 07103, USA. jean.anderson.eloy@gmail.com
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
authors.forename: Pratik A
authors.initials: PA
authors.lastname: Shukla
authors.forename: Osamah J
authors.initials: OJ
authors.lastname: Choudhry
authors.forename: Rahul
authors.initials: R
authors.lastname: Singh
authors.forename: James K
authors.initials: JK
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000601:surgery*; D002648:Child; D004724:Endoscopy; D005206:Fascia Lata / Q000637:transplantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D009666:Nose; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012658:Sella Turcica; D019292:Skull Base Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult