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  • Challenges and Surgical Nuances in Reconstruction of Large Planum Sphenoidale Tuberculum Sellae Defects After Endoscopic Endonasal Resection of Parasellar Skull Base Tumors

    Final Number:

    Jean Anderson Eloy MD; Pratik A Shukla BA; Osamah J. Choudhry MD, BA; James K. Liu MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Endoscopic endonasal transplanum transtuberculum resection of anterior skull base (ASB) tumors often results in large skull base defects. Recent studies have postulated that defects in this specific location may be associated with an increased rate of postoperative cerebrospinal fluid (CSF) leakage. In this study, we review our experience with reconstruction of planum/tuberculum sellae defects after endoscopic endonasal resection of ASB tumors.

    Methods: A retrospective analysis was performed on patients undergoing reconstruction of planum/tuberculum sellae defects after purely endoscopic endonasal transplanum transtuberculum resection of parasellar tumors.

    Results: Eighteen patients who underwent 21 repairs with a pedicled nasoseptal flap (PNSF) were identified. The mean age was 49.6 years (range, 18-68 years). The average defect size was 5.6 cm2 (range, 2.16 – 10.36 cm2). Three patients necessitated a repeat procedure due to the following: delayed CSF leak after office nasal debridement, occult benign intracranial hypertension, and intraventricular tension pneumocephalus. All 3 revisions were reconstructed with the previously used PNSF. The mean follow-up period was 8.3 months (range, 1 to 17 months). The overall success rate was 85.7 % for planum/tuberculum sellae defects, as compared to 96.8% for our overall comprehensive PNSF experience for all types of skull base defects.

    Conclusions: Repair of large planum/tuberculum sellae defects after endoscopic resection of ASB tumors presents a unique challenge. Using a PNSF along with meticulous multi-layer closure may help decrease postoperative CSF leaks. Undiagnosed pathologies such as benign intracranial hypertension should be identified since they can compound the risk of failure. Although we do not routinely use postoperative CSF diversion in planum/tuberculum sellae repairs, this may be necessary in select cases, such as benign intracranial hypertension, to prevent postoperative CSF leakage.

    Patient Care: Improve the methods of skull base reconstruction after endoscopic skull base surgery to prevent CSF leakage.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) understand the importance of endoscopic skull base reconstruction using the nasoseptal flap; 2) appreciate the challenges involved with reconstructing transplanum skull base defects; 3) discuss nuances involved in reparing transplanum defects with the nasoseptal flap.


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