Endoscopic Reconstruction of a Total Sella Defect with Nasoseptalflap

ABSTRACT

Cerebrospinal fluid (CSF) leakage is a possible major complication in skull base surgery. Application of the expanded endoscopic endonasal approach in skull base surgery expands the accessibility to resect skull base lesions but also increases the risk of CSF leakage due to the creation of larger dural defects in the skull base. Reconstruction of the skull base with multilayered autologous materials has been a key surgical technique. A recent advance in skull base reconstruction is nasoseptal flap, a robust reliable vascular pedicled flap supplied with the septal branch of the sphenopalatine artery. This technique has been reported to significantly decrease the risk of CSF leakage. We report a case of giant pituitary adenoma involving the suprasellar space and sphenoid sinus with a near total sellar defect. The lesion was removed using the endoscopic endonasal transsphenoidal approach, and the sellar floor was successfully reconstructed using a nasoseptal flap with no other multilayered support.