Application of autologous pedicled nasal mucosal flaps by "three-step" strategy in repairing of cerebrospinal fluid leakage following transsphenoidal pituitary adenoma surgery.
10.13201/j.issn.2096-7993.2025.07.007
- Author:
Shiyin QIN
1
;
Zhuohui LIU
1
;
Fengfeng JIA
1
;
Biao RUAN
1
;
Ruiqing LONG
1
Author Information
1. Department of Otolaryngology，the First Affiliated Hospital of Kunming Medical University，Kunming，650032，China.
- Publication Type:Journal Article
- Keywords:
cerebrospinal fluid leakage;
nasal endoscopy;
nasal pedicled mucosal flap;
pituitary adenoma
- MeSH:
Humans;
Retrospective Studies;
Pituitary Neoplasms/surgery*;
Surgical Flaps;
Nasal Mucosa/surgery*;
Cerebrospinal Fluid Leak/surgery*;
Adenoma/surgery*;
Postoperative Complications/surgery*;
Male;
Female;
Middle Aged;
Adult;
Aged
- From:
Journal of Clinical Otorhinolaryngology Head and Neck Surgery
2025;39(7):640-645
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To assess the efficacy of "three-step" strategy for preparing autologous pedicled nasal mucosal flaps in repairing cerebrospinal fluid（CSF） leaks following transsphenoidal pituitary adenoma surgery. Methods:A retrospective study was conducted on the clinical data of 25 patients who developed CSF leaks after transsphenoidal pituitary adenoma surgery at the First Affiliated Hospital of Kunming Medical University between July 2012 and June 2022. Surgical repair was selected step by step using nasal septal mucosal flap with either the posterior septal artery or septal branch of the sphenopalatine artery as the pedicle, or a pedicled middle turbinate mucosal flap. All patients underwent ≥2-year endoscopic follow-up to assess flap viability and CSF leak recurrence. Results:The median postoperative hospital stay was 4 days. Five patients developed intracranial infections postoperatively. The follow-up period ranged from 2 to 12 years. Nasal endoscopic examinations showed good mucosal flap growth, with no recurrence of CSF leakage in any of the patients. Conclusion:High-flow cerebrospinal fluid（CSF） leaks following pituitary tumor surgery pose significant challenges for clinical repair. Based on intraoperative nasal septal mucosal preservation and the condition of sellar base CSF leakage, the "three-step" strategy for preparing autologous pedicled nasal mucosal flaps-utilizing posterior septal artery, ethmoidal artery-based, or pedicled middle turbinate mucosal flaps sequentially-is a safe and effective repair method.
