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CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(04): 946-951
DOI: 10.4103/ajns.AJNS_37_20
Original Article

Free mucosal graft for reconstruction after nonfunctional pituitary adenoma surgery

Carlos Perez-Lopez
Department of Neurosurgery, University Hospital La Paz, Madrid
,
Alexis Palpan
Department of Neurosurgery, University Hospital La Paz, Madrid
,
Álvaro Zamarrón
Department of Neurosurgery, University Hospital La Paz, Madrid
,
Carolina Alfonso
1   Department of Ear, Nose and Throat, University Hospital La Paz, Madrid
,
Álvaro De Arriba
1   Department of Ear, Nose and Throat, University Hospital La Paz, Madrid
,
Javier Giner
Department of Neurosurgery, University Hospital La Paz, Madrid
,
Alberto Isla
Department of Neurosurgery, University Hospital La Paz, Madrid
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Background: In the search for an effective closure without nasosinusal morbidity, we have studied the efficacy of free mucosal graft as a reconstructive technique of the sellar floor after the resection of nonfunctioning pituitary adenomas (NFPA). Methods: In 100 endonasal endoscopic surgeries, we analyzed the personal history, radiological and intraoperative aspects that could have an impact on the risk of postoperative cerebrospinal fluid (CSF) leak. They were divided into three groups: no mucosa flap/graft, mucosal free graft, and nasoseptal pedicled flap. Results: The characteristics of the patients and adenomas were the same in all three groups. Intraoperative CSF leak was observed in 1/13 cases of the group without graft/flap (7%), in 16/50 of the free mucosal graft (32%) and 12/37 (32%) of pedicle flap. The proportion of cases in which other means of reconstruction were used in addition (fat, collagen matrix, and sealant) was similar in the different groups. No CSF leaks were observed, except for a doubtful one in the free mucosal graft group, which resolved spontaneously within 24 h, without receiving any type of treatment. Conclusions: The middle turbinate free mucosal graft can be of great value in endonasal surgery: It achieves a hermetic closure in cases of low-flow CSF leaks, it can be useful as a rescue for cases where nasoseptal mucosa is not available to perform a pedicled nasoseptal flap, minimizes the nasosinusal complications of the pedicled flap by leaving a smaller surface area of the nasal cavity devoid of the mucosa, and achieves greater nasosinusal functionality because proper reepithelialization occurs in the area.

Key-words:

Adenoma - cerebrospinal fluid leak - free mucosal graft - nonfunctioning

Financial support and sponsorship

Nil.




Publication History

Received: 30 January 2020

Accepted: 01 July 2020

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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