Application of a Gasket-Seal Technique Using Autogenous Bone Flap and Artificial Dura for Sellar Floor Reconstruction in Endoscopic Transnasal Pituitary Surgery

The objective of this paper is to investigate the feasibility and advantages of the gasket-seal technique using an autologous bone flap combined with artificial dura mater, following endoscopic transnasal resection of pituitary tumors.

The clinical data of 144 patients who underwent endoscopic transnasal pituitary tumor resection surgery were collected from January 2020 to April 2024 at the Affiliated Hospital of Xuzhou Medical University. Thirty patients who underwent reconstruction with autologous bone flap combined with artificial dura mater using the Gasket-Seal technique were selected as experimental group A. The control group was divided into 2 subgroups, B and C: group B consisted of 47 patients with autologous bone flap combined with pedicled nasal septum mucosal flap, and group C consisted of 67 patients with autologous soft tissue (fat, fascia lata) combined with pedicled nasal septum mucosal flap. The operation time, intraoperative Kelly grading scale, incidence of postoperative complications, and postoperative nasal function scores of the 3 groups were compared. The Sinonasal Outcome Test-22 (SNOT-22) was used to evaluate the postoperative nasal function among the 3 groups.

The operation time of the patients in group A was 3.15 ± 0.68 hours. The operation times of groups B and C were 3.90 ± 0.77 hours and 3.61 ± 0.84 hours, respectively. The operation time was shortest in group A, which was the experimental group (P<0.05). No significant difference was observed in intraoperative Kelly grading among the 3 groups (P>0.05). There was no statistically significant difference in the incidence of postoperative complications among the 3 groups (P>0.05). The SNOT-22 score of patients in group A was 3.50 (range: 0.00-6.50) points. The SNOT-22 scores in groups B and C were 9.00 (range: 5.50-11.00) points and 10.00 (range: 8.00-13.00) points, respectively. The SNOT-22 score of patients in the experimental group was the lowest (P<0.05).

The gasket-seal reconstruction technique using an autogenous bone flap and artificial dura achieves close anatomic restoration of the sellar floor. This technique shortens the operation time, reduces nasal trauma, and protects olfactory function. It can be considered a viable option for clinical use.