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Updated: Jan 16, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Arachnoid prolapse reduction with flapless reconstruction technique in pituitary adenomas treated with endoscopic
Mariano Montes de Oca-Delgado1, Jaime Jesús Martínez-Anda2, Gerardo Guinto-Balanzar3
1Department of Neurosurgery, Instituto de Seguridad Social del Estado de México y Municipios (ISSEMyM), Metepec, State of Mexico, Mexico.
Background:
Effective reconstruction of the pituitary fossa following, transsphenoidal surgery is critical in the prevention of postoperative cerebrospinal fluid, (CSF) leaks and empty sella syndrome. Therefore, reducing arachnoid prolapse into, the sphenoidal sinus is essential to avoid these and other complications.
Objective:
This study aims to identify factors that are related to arachnoid prolapse into the sphenoidal sinus. As secondary objective we propose a novel flapless reconstruction technique and prove its effectiveness in avoiding postoperative CSF leak.
Methods:
A case-control study was conducted including patients with and without arachnoid prolapse. We analyzed the clinical and surgical results of a novel arachnoid prolapse involving reduction technique with resorbable oxidized cellulose material and flapless multilayer reconstruction in patients surgically treated by transsphenoidal endoscopic surgery with diagnosis of pituitary adenoma.
Results:
Between January 2014 and December 2024, 105 patients were included in this study. Intraoperatively, tumor consistency was soft in 71.4 % of cases; arachnoid prolapse occurred in 45.8 % of patients, and 3.8 % developed postoperative CSF leak. Factors related to arachnoid prolapse were tumor resection technique, wider diaphragma sellae (DS) area, gross total resection and soft tumor consistency.
Conclusions:
The most important factor to found arachnoid prolapse during endoscopic transsphenoidal surgery is to have intact arachnoid membrane. If this condition is fulfilled, all the previously mentioned factors are related to the development of the prolapse. Flapless reconstruction technique for arachnoid prolapse reduction using resorbable oxidized cellulose, is a safe and effective alternative to nasoseptal flaps, offering comparable protection against postoperative complications with significantly fewer sinonasal complications.
