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Endoscopic reconstruction of large anterior skull base defects with opening of the sellar diaphragm. Experience at a tertiary level university hospital

Published online by Cambridge University Press:  09 September 2019

C Carnevale ,
M Tomás-Barberán ,
G Til-Pérez ,
J Ibañez-Domínguez ,
D Arancibia-Tagle ,
R Rodríguez-Villalba  and
P Sarría-Echegaray
C Carnevale
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Son Espases University Hospital, Palma de Mallorca, Spain
M Tomás-Barberán
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Son Espases University Hospital, Palma de Mallorca, Spain
G Til-Pérez
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Son Espases University Hospital, Palma de Mallorca, Spain
J Ibañez-Domínguez
Affiliation:
Department of Neurosurgery, Son Espases University Hospital, Palma de Mallorca, Spain
D Arancibia-Tagle
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Son Espases University Hospital, Palma de Mallorca, Spain
R Rodríguez-Villalba
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Son Espases University Hospital, Palma de Mallorca, Spain
P Sarría-Echegaray*
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Son Espases University Hospital, Palma de Mallorca, Spain
*
Author for correspondence: Dr Pedro Sarría-Echegaray, Department of Otolaryngology and Head and Neck Surgery, Hospital Universitario Son Espases, Carretera Valldemosa, Palma 07210, Balearic Islands, Spain E-mail: pedrosarria@orlmallorca.com Fax: +34 97 1 17 6745
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Abstract

Background

The indications for expanded endoscopic transnasal approaches continue to increase, with more complex skull base defects needing to be repaired. This study reviews the management of large anterior skull base defects with opening of the sellar diaphragm.

Method

A prospective analysis of endonasal endoscopic surgery carried out at Son Espases University Hospital between January 2013 and December 2018 was performed. The analysis included only the cases with a significative intra-operative cerebrospinal fluid leak. In all cases, reconstruction was performed by combining the gasket seal technique with a pedicled mucosal endonasal flap.

Results

Twenty-eight patients were included. The mucoperiosteal nasoseptal flap, the lateral wall flap and the middle turbinate flap were used in 13, 8 and 7 patients, respectively, combined with the gasket seal technique. One case of post-operative cerebrospinal fluid leak was observed (3.57 per cent).

Conclusion

The combination of a gasket seal with an endonasal mucosal flap is an excellent technique for repairing large anterior skull base defects.

Keywords

Skull BaseCerebrospinal Fluid LeakPituitary NeoplasmsEndoscopyFascia Lata
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 133 , Issue 10 , October 2019 , pp. 889 - 894
Copyright
Copyright © JLO (1984) Limited, 2019 

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Footnotes

Dr P Sarria-Echegaray takes responsibility for the integrity of the content of the paper

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