Presented at the Triological Society 113th Annual Meeting, Las Vegas, Nevada, U.S.A., April 30 to May 1, 2010, and at the 4th World Congress for Endoscopic Surgery of the Brain, Skull Base, and Spine, Pittsburgh, Pennsylvania, U.S.A., April 28–30, 2010.
How I Do It
Article first published online: 25 APR 2011
Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 121, Issue 5, pages 990–993, May 2011
How to Cite
Rivera-Serrano, C. M., Snyderman, C. H., Gardner, P., Prevedello, D., Wheless, S., Kassam, A. B., Carrau, R. L., Germanwala, A. and Zanation, A. (2011), Nasoseptal “Rescue” flap: A novel modification of the nasoseptal flap technique for pituitary surgery. The Laryngoscope, 121: 990–993. doi: 10.1002/lary.21419
The authors have no funding, financial relationships, or conflicts of interest to disclose.
- Issue published online: 25 APR 2011
- Article first published online: 25 APR 2011
- Accepted manuscript online: 4 JAN 2011 03:47PM EST
- Manuscript Accepted: 20 OCT 2010
- Manuscript Received: 16 JUN 2010
- Skull base;
- endoscopic surgery;
- pituitary surgery;
- nasoseptal flap;
- Level of Evidence: 4.
The introduction of the pedicled nasoseptal flap (NSF) has decreased postoperative cerebrospinal fluid (CSF) leak rates from >20% to <5% during expanded endoscopic skull base surgery. The NSF must be raised at the beginning of the operation to protect the posterior pedicle during the expanded sphenoidotomy. However, in most pituitary tumor cases, an intraoperative CSF leak is not expected but at times encountered. In these cases, a “rescue” flap approach can be 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. This technique minimized septum donor site morbidity for those patients without intraoperative CSF leaks.
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 additional donor site morbidity from the full flap harvest.
This new technique allows for sellar tumor removal prior to the nasoseptal harvest, thereby eliminating donor site morbidity for those pituitary tumor patients who do not have an intraoperative CSF leak.