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

Area of Science:

• Neurosurgery
• Otolaryngology
• Endoscopic Skull Base Surgery

Background:

• Pituitary tumors require specialized surgical approaches.
• Endoscopic endonasal surgery offers minimally invasive access.
• The rescue flap technique is crucial for managing intraoperative complications like cerebrospinal fluid leaks.

Purpose of the Study:

• To report a modified rescue flap technique using a direct endonasal approach with partial superior septectomy.
• To evaluate the efficacy of this modified technique in pituitary tumor surgery.
• To assess the utility of the nasoseptal flap in preventing cerebrospinal fluid leaks.

Main Methods:

• A prospective study involving 19 patients undergoing pituitary tumor resection.
• Utilized a direct endonasal approach with partial superior septectomy.
• Harvested a nasoseptal rescue flap when intraoperative cerebrospinal fluid leak occurred.

Main Results:

• 19 patients underwent the procedure.
• Six patients experienced intraoperative cerebrospinal fluid leaks and received a nasoseptal rescue flap.
• No postoperative cerebrospinal fluid leaks were observed in any patient.
• Two patients required a second surgery, successfully managed with the nasoseptal flap.

Conclusions:

• The direct endonasal approach with partial superior septectomy provides adequate sphenoidal sinus exposure.
• This technique preserves the nasoseptal septum, allowing for effective rescue flap utilization.
• The modified rescue flap technique is a safe and effective method for managing cerebrospinal fluid leaks during pituitary tumor surgery.