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Sellar Defect Reconstruction with Vascularized Superior Turbinate Mucosal Flaps in Endonasal Endoscopic Transsellar
Murat Kutlay1, Ozan Durmaz1, Alparslan Kırık1
1Department of Neurosurgery, University of Health Sciences, Gulhane School of Medicine, Ankara, Turkey.
World Neurosurgery
|September 25, 2019
Summary
The superior nasal turbinate (ST) flap offers a viable reconstructive option for skull base defects, particularly when the nasoseptal flap (NSF) is unavailable. This technique demonstrated successful defect coverage and flap viability in preliminary studies.
Area of Science:
- Otolaryngology
- Neurosurgery
- Head and Neck Surgery
Background:
- The nasoseptal flap (NSF) is the standard for skull base defect reconstruction in endoscopic endonasal surgery.
- The superior turbinate (ST) flap has been underutilized for these reconstructions.
- This study explores the preliminary use of the ST mucosal flap.
Purpose of the Study:
- To evaluate the efficacy and safety of the superior turbinate (ST) mucosal flap for skull base defect reconstruction.
- To assess the ST flap as an alternative or adjunct to the nasoseptal flap (NSF).
Main Methods:
- Retrospective review of 9 patients undergoing endonasal endoscopic surgery.
- Reconstruction utilized vascularized ST mucosal flaps in double-layer or triple-layer techniques.
- Technique selection (double vs. triple layer) depended on intraoperative cerebrospinal fluid (CSF) leak presence and severity.
Main Results:
- Seven of nine patients experienced intraoperative CSF leaks (4 low-flow, 3 high-flow).
- ST flaps provided complete defect coverage with preserved NSFs.
- All flaps remained viable at 4 weeks, with no CSF leaks, flap loss, or complications at 9-month follow-up.
Conclusions:
- The superior turbinate (ST) flap is a viable option for vascularized reconstruction of sellar defects when bilaterally available.
- This reconstructive strategy should be considered, especially when the NSF is not suitable.
- ST flaps offer a reliable alternative for skull base reconstruction.
