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- Title
Nasoseptal 'Rescue' Flap: A Novel Modification of the Nasoseptal Flap Technique for Pituitary Surgery.
- Authors
Rivera-Serrano, Carlos M.; Snyderman, Carl H.; Gardner, Paul; Prevedello, Daniel; Kassam, Amin B.; Carrau, Ricardo L.; Germanwala, Anand; Zanation, Adam
- Abstract
Objectives: The introduction of the pedicled nasospetal flap (NSF) has decreased postoperative CSF leak rates from >20% to <5% during expanded endoscopic skull base surgery. The NSF is routinely raised at the beginning of the operation to protect the posterior pedicle during sphenoidotomy. However, in most pituitary tumor cases an intraoperative CSF leak is not expected. In these cases, a rescue flap approach is used, which consists of partially harvesting the most superior and posterior aspect of the flap to protect its pedicle and provide access to the sphenoid face during the approach. The "Rescue Flap" can be fully harvested at the end of the case if the resultant defect is larger than expected, or if an unexpected CSF leak develops. Methods: Technical Report Results: The rescue flap technique allows for binaural and bimanual access to the sella without compromise of the pedicle during the extended sphenoidotomies and tumor removal. If an intraoperative CSF leak is encountered, the rescue flap is then converted into a normal nasoseptal flap for skull base reconstruction. If no leak is obtained, then the patient does not suffer the donor site morbidity from the full flap harvest. Conclusions: This new technique allows for sellar tumor removal prior to the nasoseptal harvest; thereby, eliminating donor site morbidity for those pituitary tumor patients whom do not have an intra operative CSF leaks.
- Subjects
PITUITARY surgery; NASAL septum; CEREBROSPINAL fluid; ENDOSCOPIC surgery; SKULL base; SURGERY
- Publication
Laryngoscope, 2010, Vol 120, Issue S3, pS122
- ISSN
0023-852X
- Publication type
Article
- DOI
10.1002/lary.21329