Endoscopic Reconstruction of Postoperative Sellar Floor Defects Using Sphenoid Sinus Mucosal-Free Graft

Objective: We report our experience in reconstructing postoperative defects of sellar floor using endoscopic placement of sphenoid sinus mucosa.

Methods: During the opening and after removal of anterior wall of sphenoid sinus we harvested the sinus mucosa as one piece and in presence of septum it is harvested as two large pieces and kept in warm saline till end of the procedure to be put on-lay graft as one layer of our layered ordinary repair with piece of septal bone then the sphenoid sinus filled with Gelfoam as support of mucosal free graft, we didn't use any nasal pack.

Results: Twenty consecutive patients with sellar and suprasellar tumors underwent endoscopic transnasal transsphenoid resection, thirteen patients underwent primary resection of pituitary macroadenomas, one case of Rathke's cleft cyst, two cases of craniopharyngioma and four cases of recurrent pituitary macroadenoma. Intraoperative cerebrospinal fluid leaks were noted in twelve patients. Sellar floor repairs after trans-sphenoidal hypophysectomy were successful in all patients. Six patients required repeated lumbar tap and another one patient had lumbar drain for five days. All patients discharged without any cerebrospinal fluid leak, no morbidity related to repair was noted.

Conclusion: Sphenoid sinus mucosa could be used successfully for the reconstruction of sellar floor after endoscopic transsphenoid resection of sellar and suprasellar tumors. It is easily harvested, manipulated and provide effective seal without donor site morbidity.