ENDOSCOPIC SELLER RECONSTRUCTION IN ENDOSCOPIC ENDONASAL TRANS SPHENOIDAL SURGERY: A REVIEW OF 100 CASES

Hwshyar Ali Ahmed; Muaid Ismail Aziz

doi:10.46903/gjms/23.2.1796

ENDOSCOPIC SELLER RECONSTRUCTION IN ENDOSCOPIC ENDONASAL TRANS SPHENOIDAL SURGERY: A REVIEW OF 100 CASES

Hwshyar Ali Ahmed, Muaid Ismail Aziz

Abstract

Background: Endoscopic endonasal transsphenoidal surgery (EETS) is the primary approach for sellar pathologies, but effective reconstruction to prevent cerebrospinal fluid (CSF) leaks remains critical. The current study reported a single institutional experience with using different types of flaps for reconstructing sellar defect in selected cases.

Materials & methods: A retrospective analysis of 100 patients undergoing EETS for sellar/suprasellar lesions (2016–2022) was conducted. Reconstruction techniques included: multilayer closure with nasoseptal flap (NSF, 64%), multilayer with middle turbinate (MT) graft (29%), and gasket-seal with NSF (7%). Outcomes assessed included intraoperative/postoperative CSF leaks (graded using Esposito classification), complications, and olfactory function (Sniffin’ Sticks test).

Results: Overall postoperative CSF leak rate was 2%. Intraoperative CSF leaks occurred in 36% of cases (Grade 1:14%, Grade 2:13%, Grade 3:9%). The facia lata + NSF technique demonstrated superior intraoperative leak prevention (no leak in 57.97% of cases, p≤0.001), especially for thin (100% success) and open (77.42% success) diaphragms. However, NSF use correlated with higher septal perforation (86.4%) and sinusitis (50%) rates. Olfaction remained stable pre- vs. postoperatively (mean scores: 12.58 vs. 12.56).

Conclusions: Sellar reconstruction is a critical component of trans-nasal hypophysectomy, impacting patient outcomes and complications. The choice of graft material, surgical technique, and attention to detail are essential in achieving successful reconstruction and minimizing postoperative complications.

Keywords

Endoscopy; Nasal Septum; Surgical Flaps; Sella Turcica.

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DOI: https://doi.org/10.46903/gjms/23.2.1796