Cerebrospinal fluid (CSF) leakage is a possible major complication in skull base surgery. Application of the expanded endoscopic endonasal approach in skull base surgery expands the accessibility to resect skull base lesions but also increases the risk of CSF leakage due to the creation of larger dural defects in the skull base. Reconstruction of the skull base with multilayered autologous materials has been a key surgical technique. A recent advance in skull base reconstruction is nasoseptal flap, a robust reliable vascular pedicled flap supplied with the septal branch of the sphenopalatine artery. This technique has been reported to significantly decrease the risk of CSF leakage. We report a case of giant pituitary adenoma involving the suprasellar space and sphenoid sinus with a near total sellar defect. The lesion was removed using the endoscopic endonasal transsphenoidal approach, and the sellar floor was successfully reconstructed using a nasoseptal flap with no other multilayered support.
Arteries ; Floors and Floorcoverings ; Pituitary Neoplasms ; Skull Base ; Sphenoid Sinus ; Surgical Flaps

OBJECTIVES: While a severe to profound sudden sensorineural hearing loss (SSNHL) may cause serious disability in verbal communication, there have been little studies focusing on this high degree SSNHL. The present study was aimed to investigate the characteristics of hearing recovery in a high degree SSNHL (>70 dB). METHODS: Three hundred and two SSNHL patients were enrolled. For a long-term follow-up, 46 patients were evaluated. Hearing level was examined by pure tone audiometry on day 1, week 3, month 3, month 6, and year 1 or after. According to the degree of the initial hearing loss, the patients were divided into 4 groups from 70 to > or =100 dB. RESULTS: After 3 weeks, the recovery rate and mean hearing gain was 61%, 23.85 dB in the 70 dB group, whereas 10%, 6.61 dB in the > or =100 dB group. There was a significant correlation between 3-week recovery and final hearing outcome. However, there was almost no recovery after 3 months. CONCLUSION: An early recovery can be a prognostic factor for the final recovery in severe to profound SSNHL. Since recovery after 3 months is rare, an early hearing intervention like hearing aid or cochlear implantation should be considered in the high degree SSNHL to restore the patient's verbal communication.
Audiometry ; Cochlea ; Cochlear Implantation ; Cochlear Implants ; Ear, Inner ; Follow-Up Studies ; Hearing ; Hearing Aids ; Hearing Loss ; Hearing Loss, Sensorineural* ; Hearing Loss, Sudden ; Humans ; Treatment Outcome