Tissues with Preserved Trophy for Post-Op: Defects Closure in Transsphenoidal Endoscopic Scull-Base Surgery

Now we have an experience of 5000 pure endoscopic removal of endo-extrasellar tumors and 204 extended approaches. High risk of post-op CSF-leakage assign a quality of cranial base reconstruction. Multilayer technique known as a standard. In some cases we try to use tissues with preserved trophy.

Materials and Methods: We use turned back middle turbinate (MT) in 30 cases and mucoperiosteal flap (MPF) in 210. For MT mobilization we cut the anterior 2\3 of it pedicle. For MPF we use Haddat methodic in one or both nostril. We used MT and MPF either for direct defect closure or for the last layer of “sandwich.” We prefer a different strategy in different surgical situation.

Results: We had only one smooth CSF-leakage in case with direct closure by MT 3weeks after the operation. We have two major and recurrent and one smooth CSF-leakage with MPF-closure. Our differentiated strategy for scull-base closure decreased CSF-leakage to <6% in cases with high-risk of SCF-leakage.

Conclusion: On our opinion MT is a good material for small sellar defect closure but it's better to use for mechanical fixation for other material (fat in sphenoid sinus). MPF is a good material for using alone or like a different layer in a “sandwich.” MPF is non-alternative material for CSF-closure in cases with meningitis.