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Updated: May 7, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Bilateral nasoseptal flaps for endoscopic endonasal transsphenoidal approach
Ji-Hyeon Shin1, Seok-Gu Kang, Sung Won Kim
1From the Departments of *Otolaryngology-Head and Neck Surgery and †Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul, Korea. ‡Minimal Access and Robotic Surgery Center, Seoul St. Mary's Hospital, Seoul, Korea.
Elevating bilateral nasoseptal flaps during endoscopic endonasal transsphenoidal surgery (EETSA) offers excellent skull base defect reconstruction and coverage. This technique effectively manages cerebrospinal fluid (CSF) leaks and sinus mucosa loss, minimizing septal defects.
Area of Science:
- Neurosurgery
- Otolaryngology
- Skull Base Surgery
Background:
- Cerebrospinal fluid (CSF) leaks are a complication of endoscopic endonasal transsphenoidal approach (EETSA).
- Nasoseptal flaps are utilized for reconstruction of skull base defects following EETSA.
- The utility of bilateral nasoseptal flap elevation in conjunction with EETSA requires further evaluation.
Purpose of the Study:
- To evaluate the usefulness of elevating bilateral nasoseptal flaps during EETSA.
- To assess the efficacy of bilateral nasoseptal flaps in reconstructing skull base defects and managing CSF leaks.
- To determine the impact of bilateral nasoseptal flap elevation on surgical outcomes and complications.
Main Methods:
- Retrospective review of 67 patients (71 procedures) who underwent EETSA with bilateral nasoseptal flap elevation.
- Analysis of demographic data, surgical procedures, outcomes, and complications.
- Documentation of flap usage for reconstruction, sinus coverage, and repositioning.
Main Results:
- Bilateral nasoseptal flap elevation provided complete exposure of the sellar floor.
- No postoperative CSF leaks occurred in any patients.
- Flaps were successfully used for reconstruction in 14 cases and sinus coverage in 13 cases, with good healing and minimal complications (two cases of bleeding, one septal perforation in a revision case).
Conclusions:
- Bilateral nasoseptal flap elevation is a valuable technique for EETSA, facilitating defect reconstruction and sinus coverage.
- The technique effectively prevents postoperative CSF leaks and allows for repositioning of unused flaps to minimize septal defects.
- Elevating bilateral nasoseptal flaps is a versatile surgical approach applicable in various EETSA scenarios, including revision surgeries.
