Skull Base Reconstruction Following Endoscopic Pituitary Surgery: A Global Survey

This study aimed to better learn how pituitary surgery centers around the world perform the reconstruction step of endoscopic endonasal transsphenoidal pituitary surgery and to understand the rationale behind their strategies.

Survey.

Representatives of 311 centers across 54 countries were invited.

Online 15-question questionnaire.

Representatives of 121 centers from 36 countries responded to the survey. We recorded a preference for multilayer reconstruction in all scenarios presented. In cases of intraoperative cerebrospinal fluid (CSF) leak and extended approaches, respondents reported greater use of autologous materials, such as fat grafts, fascia lata, and pedicled flaps. Although there was no statistical significance for most of the scenarios analyzed, we observed a greater tendency to use pedicled flaps in centers with ENT specialists on the team and a lower likelihood of using them in centers with a higher surgical volume. For cases where no CSF leak is expected preoperatively, the overall preference was for the use of rescue flaps (56.10%), especially in centers in which an ENT surgeon was present (69.77%). Once a nasoseptal flap has been created, the preference is for the nasal septum to heal by secondary intention (52.23%).

This survey provides additional evidence of the wide variability in practice and strategies among specialized pituitary/skull base surgery centers worldwide. Trends toward multilayer reconstruction, use of the nasoseptal flaps, and autologous grafts were observed. The presence of an otolaryngologist on the team influences the reconstruction strategy adopted at the institution.