Endoscopic Sellar Floor Reconstruction with Concha Bullosa Bone Autograft and Nasal Septal Flap: Technical Case Report

Abstract

Introduction: A novel method is introduced for sellar floor reconstruction after expanded endoscopic endonasal transsphenoidal surgery using concha bullosa bone autograft and vascularized, posteriorly based flaps of septal mucoperichondrium.

Case Report: A 62-year-old woman presented to her primary care physician with the insidious onset of enlarging hands and feet, coarsening of facial features, and bilateral carpal tunnel syndrome. Endocrine studies revealed elevated growth hormone (22 ng/mL) and somatomedian-C (810 ng/mL) levels. Brain magnetic resonance imaging displayed a 1.2-cm pituitary adenoma. The patient was diagnosed with acromegaly secondary to a pituitary adenoma and underwent expanded endoscopic endonasal transsphenoidal surgery for tumor resection. Preoperatively, the patient was noted to have abnormal right middle turbinate pneumatization (concha bullosa). Following adenoma resection, the sellar floor was reconstructed using concha bullosa bone autograft resected during the endonasal approach. Bilateral vascularized nasoseptal mucosal flaps were then placed over the sellar floor.

Conclusion: In patients with concha bullosa, conchal bone provides a useful substrate for sellar reconstruction after endoscopic endonasal transsphenoidal surgery.

concha bullosa - endonasal - endoscope - nasal septal flap - pituitary adenoma - transsphenoidal surgery

References

• 1 Cappabianca P, Cavallo LM, Esposito F. et al . Sellar repair in endoscopic endonasal transsphenoidal surgery: results of 170 cases.  Neurosurgery. 2002;  51 1365-1372
• 2 Kubo S, Hasegawa H, Inui T. et al . Suture knot on the repair splint: a simple method to facilitate reconstruction of the sella turcica during endonasal endoscopic transsphenoidal surgery. Technical note.  J Neurosurg. 2005;  102 938-939
• 3 Kelley RT, Smith 2nd JL, Rodzewicz GM. Transnasal endoscopic surgery of the pituitary: modifications and results over 10 years.  Laryngoscope. 2006;  116 1573-1576
• 4 Lloyd GA, Lund VJ, Scadding GK. CT of the paranasal sinuses and functional endoscopic surgery: a critical analysis of 100 symptomatic patients.  J Laryngol Otol. 1991;  105 181-185
• 5 Stallman JS, Lobo JN, Som PM. The incidence of concha bullosa and its relationship to nasal septal deviation and paranasal sinus disease.  AJNR Am J Neuroradiol. 2004;  25 1613-1618
• 6 Hadad G, Bassagasteguy L, Carrau RL. et al . A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap.  Laryngoscope. 2006;  116 1882-1886
• 7 Cappabianca P, Cavallo LM, Colao A. et al . Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas.  J Neurosurg. 2002;  97 293-298
• 8 Liu JK, Orlandi RR, Apfelbaum RI. et al . Novel closure technique for the endonasal transsphenoidal approach.  Technical note. J Neurosurg. 2004;  100 161-164
• 9 Nakagawa T, Asada M, Takashima T. et al . Sellar reconstruction after endoscopic transnasal hypophysectomy.  Laryngoscope. 2001;  111 2077-2081
• 10 El-Banhawy OA, Halaka AN, El-Dien AE. et al . Sellar floor reconstruction with nasal turbinate tissue after endoscopic endonasal transsphenoidal surgery for pituitary adenomas.  Minim Invasive Neurosurg. 2003;  46 289-292
• 11 Lorenz RR, Dean RL, Hurley DB. et al . Endoscopic reconstruction of anterior and middle cranial fossa defects using acellular dermal allograft.  Laryngoscope. 2003;  113 496-501
• 12 Seiler RW, Mariani L. Sellar reconstruction with resorbable vicryl patches, gelatin foam, and fibrin glue in transsphenoidal surgery: a 10-year experience with 376 patients.  J Neurosurg. 2000;  93 762-765
• 13 Yano S, Tsuiki H, Kudo M. et al . Sellar repair with resorbable polyglactin acid sheet and fibrin glue in endoscopic endonasal transsphenoidal surgery.  Surg Neurol. 2007;  67 59-64

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