Utility of sphenoid mucosal flaps in transnasal transsphenoidal surgery

Yoon, Tae Mi; Lim, Sang-Chul; Jung, Shin

doi:10.1080/00016480701730752

Cited by 10 publications

(18 citation statements)

References 8 publications

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“…1A) or CSF leakage that was not detected during the operation can occur after the operation, proper reconstruction is necessary. In this case, depending on the surgeon's choice, an autologous mucosal graft [20] or sphenoid mucosal flap [21] is typically considered. When approaching the sphenoid sinus, the surgeon creates a superior or inferior based sphenoid mucosal flap and then resects the tumor.…”

Section: Gradementioning

confidence: 99%

Reconstruction Strategy After Endoscopic Skull-Base Surgery

Hong

2022

J Rhinol

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Endoscopic skull-base surgery (ESBS) is a rapidly growing surgical area that involves collaboration of otolaryngology-head and neck surgeons and neurosurgeons. Various tumor pathologies and extents have been successfully treated with ESBS, and diverse reconstruction methods have been adopted since its introduction. The optimal reconstructive strategy should be based on heterogeneous surgical situations and tumor extent. Nevertheless, there are few current guidelines for selecting reconstructive methods. Therefore, we review diverse options for endoscopic skull-base reconstruction.

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Section: Gradementioning

confidence: 99%

Reconstruction Strategy After Endoscopic Skull-Base Surgery

Hong

2022

J Rhinol

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“… 37 , 38 The normal mucosal regrowth that occurs following such repairs is believed to create permanent barrier across the defect, hence the importance of the presence of healthy mucosa within the sinuses during the healing process. 39 , 40 Hadad et al 41 described the early use of the local nasoseptal flap to cover defects in the skull base and prevent CSF fistula progression. In this setting, the vascular supply from the tissue pedicle alleviates need for mucosal in-growth across a defect.…”

Section: Durability Of Csf Leak Repairmentioning

confidence: 99%

Late Onset of CSF Rhinorrhea in a Postoperative Transsphenoidal Surgery Patient Following Robotic-Assisted Abdominal Hysterectomy

Dowdy

Moody

Cifarelli

2014

Journal of Investigative Medicine High Impact Case Reports

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Cerebrospinal fluid (CSF) leak is the most commonly encountered perioperative complication in transsphenoidal surgery for pituitary lesions. Direct closure with a combination of autologous fat, local bone, and/or synthetic grafts remains the standard of care for leaks encountered at the time of surgery as well as postoperatively. The development of the vascularized nasoseptal flap as a closure technique has increased the surgeon’s capacity to correct even larger openings in the dura of the sella as well as widely exposed anterior skull base defects. Yet these advances in the technical nuances for management of post-transsphenoidal CSF leak are useless without the ability to recognize a CSF leak by physical examination, clinical history, biochemical testing, or radiographic assessment. Here, we report a case of a patient who developed a CSF leak 28 years after transsphenoidal surgery, precipitated by a robotic-assisted hysterectomy during which increased intra-abdominal pressure and steep Trendelenberg positioning were both factors. Given the remote nature of the patient’s transsphenoidal surgery and relative paucity of data regarding such a complication, the condition went unrecognized for several months. We review the available literature regarding risk and pathophysiology of CSF leak following abdominal surgery and propose the need for increased vigilance in identification of such occurrences with the increasing acceptance and popularity of minimally invasive abdominal and pelvic surgeries as standards in the field.

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“…Furthermore, sphenoid mucosal repositioning has been used to prevent CSF leakage. Such repositioning facilitates postoperative healing 5,6 …”

Section: Introductionmentioning

confidence: 99%

“…Such repositioning facilitates postoperative healing. 5,6 Although the rate of complications (such as CSF leakage) is greatly reduced using these various surgical methods, the recurrence rate after surgical treatment of a pituitary adenoma (which recurs most frequently in the sellar region) is 30%. 7 In some instances, the posterior wall of the sphenoid sinus is extremely hypertrophic during re-operation; in other instances, it is not.…”

Section: Introductionmentioning

confidence: 99%

Changes in the Sphenoid Bone Encountered During the Endoscopic Endonasal Transsphenoidal Approach

et al. 2022

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Objectives We estimated volume changes in the posterior bony wall of the sphenoid sinus, as well as alterations in nasal function (including olfactory function and subjective symptoms), after sphenoid mucosal repositioning using the endoscopic endonasal transsphenoidal approach (EETSA). Methods During 2010 and 2021, 13 patients underwent sphenoid mucosal repositioning during EETSA, while 24 patients (the control group) did not. Pre‐ and postoperative paranasal sinus computed tomography and the Mimics program were used to evaluate three‐dimensional changes in the posterior wall of the sphenoid sinus. All patients underwent the Connecticut Chemosensory Clinical Research Center (CCCRC) test, the Cross‐Cultural Smell Identification Test (CCSIT), Nasal Obstruction Symptoms Evaluation (NOSE), the Sino‐Nasal Outcome Test‐20 (SNOT‐20), and visual analog scale (VAS) evaluation. Results The increase in the volume of the posterior wall of the sphenoid sinus after surgery was objectively smaller in the sphenoid mucosal repositioning group than in the control group (P = .046). However, this did not affect olfactory function (as revealed by the CCCRC test or the CCSIT) or subjective symptoms (as revealed by the NOSE, SNOT‐20, and VAS scores) (all P > .05). Conclusion Surgical closure via sphenoid mucosal repositioning during EETSA reduces the volume of the posterior wall of the sphenoid sinus and facilitates re‐operation. We suggest that sphenoid mucosal repositioning is appropriate during EETSA. Level of Evidence 4 Laryngoscope, 132:965–972, 2022

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Utility of sphenoid mucosal flaps in transnasal transsphenoidal surgery

Cited by 10 publications

References 8 publications

Reconstruction Strategy After Endoscopic Skull-Base Surgery

Reconstruction Strategy After Endoscopic Skull-Base Surgery

Late Onset of CSF Rhinorrhea in a Postoperative Transsphenoidal Surgery Patient Following Robotic-Assisted Abdominal Hysterectomy

Changes in the Sphenoid Bone Encountered During the Endoscopic Endonasal Transsphenoidal Approach

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