Posterior nasoseptal flap in the reconstruction of skull base defects following endonasal surgery

Singh, Chandra Veer; Shah, Nishit

doi:10.1017/s0022215119000926

Cited by 6 publications

(2 citation statements)

References 16 publications

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“…Principle disadvantages of NSF included sinonasal morbidity (e.g. crusting, loss of smell, sinusitis, nasal perforations, adhesions, synechiae) and potential iatrogenic damage to the raised flap/ pedicle intraoperatively [52, [122][123][124]. Rivera-Serrano et al described the "rescue" NSF technique, which allows protection of the vascular pedicle early in the operation so that the choice to raise a full NSF or not is available at the reconstruction phase of the operation [125].…”

Section: Barrier Restoring: Nasalmentioning

confidence: 99%

Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review

et al. 2021

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Purpose Postoperative cerebrospinal fluid rhinorrhoea (CSFR) remains a frequent complication of endonasal approaches to pituitary and skull base tumours. Watertight skull base reconstruction is important in preventing CSFR. We sought to systematically review the current literature of available skull base repair techniques. Methods Pubmed and Embase databases were searched for studies (2000–2020) that (a) reported on the endonasal resection of pituitary and skull base tumours, (b) focussed on skull base repair techniques and/or postoperative CSFR risk factors, and (c) included CSFR data. Roles, advantages and disadvantages of each repair method were detailed. Random-effects meta-analyses were performed where possible. Results 193 studies were included. Repair methods were categorised based on function and anatomical level. There was absolute heterogeneity in repair methods used, with no independent studies sharing the same repair protocol. Techniques most commonly used for low CSFR risk cases were fat grafts, fascia lata grafts and synthetic grafts. For cases with higher CSFR risk, multilayer regimes were utilized with vascularized flaps, gasket sealing and lumbar drains. Lumbar drain use for high CSFR risk cases was supported by a randomised study (Oxford CEBM: Grade B recommendation), but otherwise there was limited high-level evidence. Pooled CSFR incidence by approach was 3.7% (CI 3–4.5%) for transsphenoidal, 9% (CI 7.2–11.3%) for expanded endonasal, and 5.3% (CI 3.4–7%) for studies describing both. Further meaningful meta-analyses of repair methods were not performed due to significant repair protocol heterogeneity. Conclusions Modern reconstructive protocols are heterogeneous and there is limited evidence to suggest the optimal repair technique after pituitary and skull base tumour resection. Further studies are needed to guide practice.

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Section: Barrier Restoring: Nasalmentioning

confidence: 99%

Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review

et al. 2021

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“…Nearly 25% of patients develop transient diabetes insipidus lasting for several days to weeks. In about 0.5% of patients, diabetes insipidus remains permanent [28,52,53].…”

Section: Immediate Postoperative Carementioning

confidence: 99%

Transnasal Endoscopic Pituitary Surgery: Indications, Technique, and Complications

Abdullah,

Osman,

Ibrahim

et al. 2024

Skull Base Surgery - Pearls and Nuances

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Pituitary neoplasm is the commonest sellar pathology, where pituitary adenoma heads the list, it accounts for 25% of all intracranial neoplasm. Although it is a benign lesion in most cases is located in a complex region; adjacent to important structures: optic chiasm, internal carotid arteries, suprasellar cistern, and cavernous sinuses, it presents with a variety of clinical scenarios. The Sella is situated at the center of the skull base, this made surgical access via craniotomy very challenging and is associated with considerable morbidity. Transnasal endoscopic pituitary surgery (TEPS) evolved rapidly, almost replacing the craniotomy approach, because it is minimally invasive and gives direct sellar access with excellent visualization. On the other hand, the learning curve of TEPS requires meticulous training to acquire surgical skills. Indications of TEPS, technique, complications, their prevention, and management are described. The multidisciplinary approach in managing pituitary adenoma is addressed, where a team of an endocrinologist, neurosurgeon, otolaryngologist, ophthalmologist, anesthesiologist, and neuroradiologist decide on a management plan for patients. Other disciplines share management of certain cases that is Oncologist, ICU specialists, and obstetrician. Long term follow-up is required by endocrinologists whereas revision surgery is considered in some patients.

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Heterogeneity in Outcome Reporting in Endoscopic Endonasal Skull Base Reconstruction: A Systematic Review

Dorismond

Santarelli

Thorp

et al. 2020

J Neurol Surg B Skull Base

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Objectives Presently, there are no standards for reporting outcomes of endoscopic endonasal skull base reconstruction (ESBR). This is problematic as a lack of consistent reporting makes synthesizing findings in systematic reviews and meta-analysis challenging. Thus, the aim of this study was to systematically review and describe the patterns of reporting outcomes in ESBR as a foundation for developing reporting guidelines. Study Design Present study is a systematic review. Methods Embase, PubMed, CINAHL, Cochrane Library, and Web of Science were searched for all publications with ≥25 patients and a focus on ESBR. The reporting patterns of each study's variables and outcomes were assessed. Results A total of 112 studies were included in the review. The most commonly reported demographic variables were the number of included patients (n = 112, 100%) and types of pathologies treated (n = 104, 92.9%). Meanwhile, the most routinely described preoperative variable was history of prior treatment (n = 48, 42.9%). Type of reconstruction was a commonly reported intraoperative variable (n = 110, 98.2%), though the rate of intraoperative cerebrospinal fluid (CSF) leak was noted in only 76 studies (67.9%). With regard to postoperative outcomes, postoperative CSF leak rate was routinely provided (n = 101, 90.2%), but reporting of other surgical complications was more inconsistent. Ultimately, of the 43 variables and outcomes reviewed, a median of 12 (range: 4–22) was reported in each study. Conclusions There is significant heterogeneity in the outcomes reported in studies relating to ESBR. This highlights the need for the development of standard reporting guidelines to minimize bias and improve interstudy comparability.

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Posterior nasoseptal flap in the reconstruction of skull base defects following endonasal surgery

Cited by 6 publications

References 16 publications

Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review

Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review

Transnasal Endoscopic Pituitary Surgery: Indications, Technique, and Complications

Heterogeneity in Outcome Reporting in Endoscopic Endonasal Skull Base Reconstruction: A Systematic Review

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