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. 2020 Oct 19;15(4):946-951.
doi: 10.4103/ajns.AJNS_37_20. eCollection 2020 Oct-Dec.

Free Mucosal Graft for Reconstruction after Nonfunctional Pituitary Adenoma Surgery

Carlos Pérez-López  1 , Alexis Junnior Palpan  1 , Álvaro Zamarrón  1 , Carolina Alfonso  2 , Álvaro De Arriba  2 , Javier Giner  1 , Alberto Isla  1
Affiliations

Free Mucosal Graft for Reconstruction after Nonfunctional Pituitary Adenoma Surgery

Carlos Pérez-López et al. Asian J Neurosurg. .

Abstract

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.

Keywords: Adenoma; cerebrospinal fluid leak; free mucosal graft; nonfunctioning.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Grouping of cases by treatment groups applied in relation to the maximum tumor dimension, tumor volume and degree of resection. We see that the three groups collect cases of similar characteristics
Figure 2
Figure 2
Algorithm for the management of the cerebrospinal fluid leak including the free mucosal graft
Figure 3
Figure 3
(a) Placing the free mucosal graft. It is easy to get a wide piece that covers a lot of surface and has a thickness that makes it resistant (b) Sagittal magnetic resonance image showing the closure of the cranial base with free mucosa, 6 months after resection of a nonfunctioning pituitary adenoma
See this image and copyright information in PMC

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