Multi-center study on sellar reconstruction after endoscopic transsphenoidal pituitary surgery

Area of Science:

• Neurosurgery
• Otolaryngology
• Endocrinology

Background:

• Sellar reconstruction is crucial after transsphenoidal surgery for pituitary tumors.
• Techniques range from no reconstruction to synthetic materials, autologous grafts, and vascularized flaps.
• Comparing efficacy and morbidity of these techniques is essential for optimal patient outcomes.

Purpose of the Study:

• To compare the efficacy and postoperative morbidity of different sellar reconstruction techniques.
• To evaluate the impact of reconstruction methods on patient outcomes and surgical complications.
• To identify factors influencing the choice of reconstruction technique.

Main Methods:

• Retrospective chart review of 501 patients undergoing endoscopic transsphenoidal surgery for pituitary tumors (Jan 2021-Mar 2023).
• Data collected included demographics, tumor characteristics, reconstruction technique, postoperative cerebrospinal fluid (CSF) leak, and Sino-Nasal Outcome Test (SNOT-22) scores.
• Statistical analysis used Fisher's exact test, ANOVA, and Kruskal-Wallis test to compare outcomes.

Main Results:

• 89% of patients had onlay reconstruction: 49% mucosal grafts, 35% nasoseptal flaps.
• Nasoseptal flaps were more common for giant tumors (>3 cm) and high-flow CSF leaks.
• Mucosal grafts were associated with shorter operating times (183 min vs. 240 min).

Conclusions:

• Sellar reconstruction techniques demonstrate comparable effectiveness and morbidity.
• Vascularized flaps are frequently used for larger tumors and significant intraoperative CSF leaks.
• The choice of technique may be influenced by tumor size and intraoperative findings.