Introduction: There are many options for dural reconstruction following endoscopic pituitary surgery and the pedicled naso-septal flap has significantly reduced reported CSF leak rates. However for standard pituitary surgery a nasoseptal flap is often not required and adds significant time to the procedure with additional potential nasal morbidity. This study aims to review the use of free middle turbinate mucosa for reconstruction following resection of pituitary adenomas.
Methods: A prospective study of a consecutive cohort of patients undergoing endoscopic endonasal pituitary surgery for pituitary adenoma. Patients having revision surgery were excluded. Patients with giant macroadenomas where a high flow CSF leak was anticipated underwent naso-septal flap reconstruction and were excluded from the study. All other patients had resection of the right middle turbinate during endonasal access and the harvested free mucosa was used to close the sella defect. No nasal packing was used. All patients were reviewed clinically at 6 weeks and 6 months post-operatively.
Results: 32 adult patients were included in the current study, 9 microadenomas (28%) and 23 macroadenomas (72%). The rate of gross total resection confirmed on post-operative MRI was 87.5%. No patients in this series experienced post-operative CSF leak. The median post-operative length of stay was 2 days (range 1 -5 days).
Conclusions: Free middle turbinate mucosal grafting provides an excellent reconstruction technique in standard pituitary surgery, without the need for additional incisions to harvest fat or the need to raise a vascularised naso-septal flap.
Patient Care: This research will improve patient care by reducing the incidence of CSF leaks after pituitary surgery.
Learning Objectives: By the conclusion of this session the participants should be able to discuss the options for dural reconstruction after endoscopic pituitary surgery