Efficacy of an Inferior Free Mucosal Graft for Sellar Reconstruction in a Neurosurgeon-Only Pituitary Practice

Background: Endoscopic endonasal approaches (EEAs) are typically performed by a surgical team consisting of neurosurgeons and otolaryngologists with the latter often performing the approach and reconstruction after the former completes the resection. While the value of this team approach is widely recognized, it is unclear how safely and effectively EEAs can be performed by a neurosurgical team alone. The utility of a free mucosal graft for sellar reconstruction has been well reported, but it is unclear if this technique applies without the expertise of an otolaryngologist.

Methods: We reviewed 68 consecutive EEA procedures in which an inferior nasal floor free mucosal graft was used for sellar reconstruction in a neurosurgery-only pituitary practice.

Results: An intraoperative low flow cerebrospinal fluid (CSF) leak was encountered in 26 procedures (38%), but with a collagen inlay allograft for primary dural repair and an onlay free mucosal graft harvested from the inferior nasal floor for sellar reconstruction, there were no postoperative CSF leaks.

Conclusion: The free mucosal graft is a simple and effective means of sellar reconstruction that can be harvested and used even without the expertise of a rhinologist.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
05 February 2024