title: Endoscopic combined "transseptal/transnasal" approach for pituitary adenoma: reconstruction of skull base using pedicled nasoseptal flap in 91 consecutive cases.
abstract: OBJECTIVE
  The purpose of this study was to describe the endoscopic combined "transseptal/transnasal" approach with a pedicled nasoseptal flap for pituitary adenoma and skull base reconstruction, especially with respect to cerebrospinal fluid (CSF) fistula.
  
  
  METHODS
  Ninety-one consecutive patients with pituitary adenomas were retrospectively reviewed. All patients underwent the endoscopic combined "transseptal/transnasal" approach by the single team including the otorhinolaryngologists and neurosurgeons. Postoperative complications related to the flap were analyzed.
  
  
  RESULTS
  Intra- and postoperative CSF fistulae were observed in 36 (40%) and 4 (4.4%) patients, respectively. Among the 4 patients, lumbar drainage and bed rest healed the CSF fistula in 3 patients and reoperation for revision was necessary in one patient. Other flap-related complications included nasal bleeding in 3 patients (3.3%).
  
  
  CONCLUSIONS
  The endoscopic combined "transseptal/transnasal" approach is most suitable for a two-surgeon technique and a pedicled nasoseptal flap is a reliable technique for preventing postoperative CSF fistula in pituitary surgery.
authors.affiliation: Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Osaka, Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Fujimoto
authors.affiliation: São Paulo ENT Center, Complexo Hospitalar Edmundo Vasconcelos, Sao Paulo, SP, Brazil.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Balsalobre
authors.affiliation: São Paulo ENT Center, Complexo Hospitalar Edmundo Vasconcelos, Sao Paulo, SP, Brazil.
authors.forename: Fábio P
authors.initials: FP
authors.lastname: Santos
authors.affiliation: DFV Neuro, Sao Paulo, SP, Brazil.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Vellutini
authors.affiliation: São Paulo ENT Center, Complexo Hospitalar Edmundo Vasconcelos, Sao Paulo, SP, Brazil.
authors.forename: Aldo C
authors.initials: AC
authors.lastname: Stamm
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065634:Cerebrospinal Fluid Leak / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005402:Fistula / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000601:surgery; D009300:Nasal Septum / Q000601:surgery; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000379:methods*; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D019291:Skull Base / Q000601:surgery*; D013524:Surgical Flaps / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult