Skull Base Reconstruction Following Endoscopic Pituitary Surgery: A Global Survey

Area of Science:

• Neurosurgery
• Otolaryngology
• Skull Base Surgery

Background:

• Endoscopic endonasal transsphenoidal pituitary surgery is a complex procedure.
• Reconstruction of the surgical site is a critical step influencing patient outcomes.
• Practices for reconstruction vary significantly among surgical centers worldwide.

Purpose of the Study:

• To investigate global practices in the reconstruction phase of endoscopic endonasal transsphenoidal pituitary surgery.
• To understand the rationale and strategies employed by different pituitary surgery centers.
• To identify factors influencing reconstruction technique selection.

Main Methods:

• A global survey was conducted among representatives of pituitary surgery centers.
• An online 15-question questionnaire was used to gather data on reconstruction strategies.
• Data were collected from 121 centers across 36 countries.

Main Results:

• A preference for multilayer reconstruction was noted across all presented scenarios.
• Autologous materials (fat grafts, fascia lata, pedicled flaps) were more frequently used in cases of cerebrospinal fluid (CSF) leak and extended approaches.
• Centers with otolaryngology specialists showed a greater tendency to use pedicled flaps, especially for cases without expected CSF leak.

Conclusions:

• Significant variability exists in pituitary/skull base surgery reconstruction strategies globally.
• Trends indicate a move towards multilayer reconstruction, nasoseptal flaps, and autologous grafts.
• The involvement of an otolaryngologist impacts institutional reconstruction strategies.