Direct Endonasal Approach with Partial Upper Posterior Septectomy. A “Rescue Flap” Technique Modification

Abstract

Objective Report a modification of the “rescue flap” technique using a direct endonasal approach with a partial superior septectomy for approaching pituitary tumors developed in our institution.

Design Prospective study.

Setting Hospital Universitario “Dr. José Eleuterio González,” Universidad Autónoma de Nuevo León.

Main Outcome Measures Since April 2015, we have performed 19 cases employing a direct endonasal approach with partial superior septectomy. Results and a technical note are described below.

Results Nineteen patients were included in this report. Six patients presented transoperatory cerebrospinal fluid (CSF) leak, so a nasoseptal rescue flap was harvested. No patients developed postoperative CSF leak in this group. Two patients were submitted to a second surgical procedure. Nasoseptal flap was harvested without complications. In both patients, the size of the flap was enough to cover the dural defect and avoid CSF leak.

Conclusion Direct endonasal approach with a partial posterior septectomy allows enough exposition of the sphenoidal sinus while preserving the nasoseptal septum with the possibility of a successful rescue flap when needed.

Keywords

endoscopy - pituitary surgery - partial septectomy - rescue flap

• References

• 1 Prevedello DM, Doglietto F, Jane Jr JA, Jagannathan J, Han J, Laws Jr ER. History of endoscopic skull base surgery: its evolution and current reality. J Neurosurg 2007; 107 (1) 206-213
• 2 Kassam AB, Thomas A, Carrau RL , et al. Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 2008; 63 (1) (Suppl. 01) ONS44-ONS52 , discussion ONS52–ONS53
• 3 Rivera-Serrano CM, Snyderman CH, Gardner P , et al. Nasoseptal “rescue” flap: a novel modification of the nasoseptal flap technique for pituitary surgery. Laryngoscope 2011; 121 (5) 990-993
• 4 Garcia-Navarro V, Anand VK, Schwartz TH. Gasket seal closure for extended endonasal endoscopic skull base surgery: efficacy in a large case series. World Neurosurg 2013; 80 (5) 563-568
• 5 Otto BA, Bowe SN, Carrau RL, Prevedello DM, Ditzel Filho LF, de Lara D. Transsphenoidal approach with nasoseptal flap pedicle transposition: modified rescue flap technique. Laryngoscope 2013; 123 (12) 2976-2979
• 6 Ozawa H, Tomita T, Watanabe Y , et al. Sigmoid incision rescue nasoseptal flap technique for endoscopic endonasal skull base surgery. Acta Otolaryngol 2016; 136 (6) 636-640
• 7 Lee DH, Yoon TM, Lee JK , et al. Clinical utility of the inferior turbinate flaps in the reconstruction of the nasal septum and skull base. J Craniofac Surg 2012; 23 (4) e322-e326
• 8 Kim H, Hong YK, Jeun SS , et al. Anatomic changes caused by endoscopic endonasal transsphenoidal surgery and their effects on nasal functions. Otolaryngol Head Neck Surg 2016; 154 (6) 1132-1137
• 9 Rowan NR, Wang EW, Gardner PA, Fernandez-Miranda JC, Snyderman CH. Nasal deformities following nasoseptal flap reconstruction of skull base defects. J Neurol Surg B Skull Base 2016; 77 (1) 14-18
• 10 Kim BY, Kang SG, Kim SW , et al. Olfactory changes after endoscopic endonasal transsphenoidal approach for skull base tumors. Laryngoscope 2014; 124 (11) 2470-2475