Transnasal trans-sphenoidal endoscopic repair of CSF leak secondary to invasive pituitary tumours using a nasoseptal flap

Abstract

Cerebrospinal fluid (CSF) leak following initiation of Dopamine agonist therapy for macroprolactinomas, although uncommon, has been described previously in the literature. Traditional management includes primary repair of the defect using either fat or fascia lata in conjunction with lumbar drain insertion. In this case series we outline two cases of CSF leak secondary to invasive pituitary tumour that were repaired successfully using a nasoseptal flap. We believe that this form of repair is effective and associated with minimal morbidity.

Challenges and surgical nuances in reconstruction of large planum sphenoidale tuberculum sellae defects after endoscopic endonasal resection of parasellar skull base tumors

“…12,43 The introduction of the vascularized pedicled nasoseptal flap (PNSF) has significantly decreased the incidence of postoperative CSF leakage after reconstruction of the cranial base following extended endoscopic endonasal approaches. 30,[44][45][46][47][48][49][50] The PNSF, as described by Hadad et al, 30 is a robust, yet flexible flap based on the posterior septal branch of the sphenopalatine artery, which provides a large surface area and superior arc of rotation that allows for a great advantage for reconstruction of large skull base defects with high-flow CSF leaks. This vascularized flap is believed to promote faster and more complete healing, and as a result decreases the risks associated with communication between the intracranial and sinonasal cavities.…”

Assessment of frontal lobe sagging after endoscopic endonasal transcribriform resection of anterior skull base tumors: Is rigid structural reconstruction of the cranial base defect necessary?

“…5, 18 Two potential setbacks of these large cribriform defects are the possibility of increased postoperative cerebrospinal fluid (CSF) leaks and delayed frontal lobe sagging (encephalocele formation) after endoscopic endonasal repair. The advent of the vascularized pedicled nasoseptal flap (PNSF) for repair of large ASB defects after endoscopic skull base surgery has significantly reduced the rate of postoperative CSF leaks 19–28. However, the degree of frontal lobe sagging after reconstruction of these large cribriform defects has not been previously investigated.…”

Triple‐layer reconstruction technique for large cribriform defects after endoscopic endonasal resection of anterior skull base tumors

“…One notable technique is the use of a single layer of nonvascularized thick acellular dermal allograft (ADA) for repair of large anterior skull base cribriform defects with a postoperative CSF leak rate of 3%, described by Germani et al in 2007. On the other hand, successful reconstruction of the cranial base with vascularized tissue has been described in order to reliably separate the intracranial contents from the paranasal sinus cavity following extended endoscopic endonasal approaches (EEAs) . Vascularized tissue promotes faster, and more complete healing, and therefore decreases the risks associated with communication between the cranial and sinonasal cavities.…”