Related Experiment Video
Updated: Dec 28, 2025
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Securing the position of the nasoseptal flap in endoscopic transsphenoidal surgery: No need for a Foley catheter
Emad A S Massoud1, Andrea L O Hebb2, David B Clarke3
1Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, QEII Health Science Centre, Halifax, NS B3H 2Y9, Canada; Division of Neurosurgery, Department of Surgery, Dalhousie University, QEII Health Science Centre, Halifax, NS B3H 3A7, Canada.
Background:
The pedicled nasoseptal mucoperiosteal flap is currently widely used for the reconstruction of a skull base defect following transsphenoidal surgery. The flap is generally secured in position by a Foley catheter balloon. We describe an alternative technique using cylinders of Gelfoam™ (Pfizer Incorporated) to buttress the flap in place, obviating the need for a balloon catheter.
Material And Methods:
A review of our database identified patients who underwent endoscopic transsphenoidal surgery for a pituitary macroadenoma with nasoseptal flap, secured with small rolls of Gelfoam™ (Pfizer Incorporated) rather than a nasal Foley catheter. Minimum follow-up clinical and MRI assessments: 3 months.
Results:
73 patients (mean follow-up: 22 months) met the inclusion criteria: 56 non-functioning and 17 functioning pituitary adenomas. 36 patients had an intraoperative CSF leak: 30 high flow and 6 low flow leaks. The surgical repair in 35 patients included fat +/- fascia graft. One patient had a post-operative CSF leak repaired by subsequent surgery without the use of a Foley catheter.
Conclusion:
Securing the nasoseptal flap using rolls of Gelfoam™ (Pfizer Incorporated) as described can be achieved without the use of a nasal Foley catheter.
