Tissues with Preserved Viability for Closure of Postoperative Defects in Transsphenoidal Endoscopic Surgery

Introduction: This study details our experience with 2000 purely endoscopic procedures for the resection of both endo and extrasellar tumors that includes 50 extended endoscopic approaches. These procedures carry a high risk of postoperative CSF-leakage due to the difficulty of reconstructing the cranial base. The multilayer technique is recognized as a standard method of closing a skull base defect. The problem is that nobody knows how to use different materials for this type of closure. In some cases, we try to use tissues with preserved viability.

Materials and Methods: We used turned back middle turbinate (MT) in 11 cases and mucoperiosteal flap (MPF) in 10.

For MT mobilization, we cut the anterior two thirds of the pedicle. For MPF, we used the Hadad method in one or both nostrils. We used MT and MPF either for direct defect closure or for the last layer of the “sandwich.”

Results: The first results are good. We had only one small CSF leak in a case with direct closure by MT 3 weeks after the operation. During the revision, the MT was absolutely fixed and it was impossible to take it off. Additional sphenoid packing resolved the problem. In two cases with MPF-closure, we saw absolute impermeability during extreme ICP elevation up to 220 and 360 mm of water.

Conclusion: On our opinion, MT is a good material for small sellar defect closure or for mechanical fixation for other material. MPF is a good material for using alone or as one layer in a “sandwich.”