title: Optimizing Sellar Reconstruction After Pituitary Surgery with Free Mucosal Graft: Results from the First 50 Consecutive Patients.
abstract: BACKGROUND
  Postoperative cerebrospinal fluid leak after endoscopic pituitary surgery ranges from 1.9% to 10% in different series. Vascularized flaps have reduced the incidence of leak; however, this carries nasal morbidity. This study presents a technique for sellar reconstruction with free mucosal graft from the nasal cavity floor including inferior meatus mucosa. This technique aims to standardize sellar reconstruction without the use of the nasoseptal flap and to keep the advantage of mucosal coverage of the defect in all cases.
  
  
  METHODS
  Fifty consecutive patients who had endoscopic surgery for pituitary tumors and reconstruction with nasal cavity floor free mucosal graft were retrospectively reviewed. There were a total of 50 patients with postoperative follow-up from 3 to 16 months. Collagen dural graft was used inlay and free mucosal graft overlay to cover the sellar defect. No fat grafts or lumbar drains were used. A Sinonasal Outcome Test-22 (SNOT-22) was performed before, 1 and 3 months after surgery.
  
  
  RESULTS
  There were 40% detected intraoperative leaks and no postoperative leaks. Nasal endoscopy performed at 1 month follow-up showed complete healing of the graft to the skull base and near total or complete mucosalization of the donor site. No significant difference was found in the SNOT-22 comparing the total preoperative and 1-month scores.
  
  
  CONCLUSIONS
  The nasal cavity floor free mucosal graft is an easy and safe technique, with minimal nasal morbidity. There were no postoperative cerebrospinal fluid leaks, despite aggressive tumor resection. No lumbar drains or fat graft were used. The harvest of mucosal graft does not worsen the quality of life measured with the SNOT-22 test.
authors.affiliation: Department of Neurosurgery, Albany Medical Center, Albany, New York, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Peris-Celda
authors.affiliation: Albany Medical College, Albany, New York, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Chaskes
authors.affiliation: Albany Medical College, Albany, New York, USA.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Albany Medical Center, Albany, New York, USA.
authors.forename: Tyler J
authors.initials: TJ
authors.lastname: Kenning
authors.affiliation: Division of Otolaryngology and Head-Neck Surgery, Department of Surgery, Albany Medical Center, Albany, New York, USA. Electronic address: pinheic@mail.amc.edu.
authors.forename: Carlos D
authors.initials: CD
authors.lastname: Pinheiro-Neto
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D000368:Aged; D065634:Cerebrospinal Fluid Leak; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000000981:diagnostic imaging / Q000601:surgery; D009297:Nasal Mucosa / Q000637:transplantation*; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012658:Sella Turcica / Q000000981:diagnostic imaging / Q000601:surgery*; D019737:Transplants / Q000637:transplantation*
keywords: Cerebrospinal fluid leak; Free mucosal graft; Nasoseptal flap; Pituitary adenoma; Sellar reconstruction; Skull base reconstruction