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. 2024 Feb 25:22:100330.
doi: 10.1016/j.wnsx.2024.100330. eCollection 2024 Apr.

Validity of the flap risk score in predicting nasoseptal flap use after endoscopic transsphenoidal pituitary mass resection

Arsalaan Salehani  1 , Matthew Parr  1 , Travis J Atchley  1 , Sasha Howell  1 , Dagoberto Estevez-Ordonez  1 , Nicholas M B Laskay  1 , Kristen Riley  1
Affiliations

Validity of the flap risk score in predicting nasoseptal flap use after endoscopic transsphenoidal pituitary mass resection

Arsalaan Salehani et al. World Neurosurg X. .

Abstract

Introduction: There remains a paucity of literature examining the decision algorithm for use of nasoseptal flap (NSF) after endoscopic endonasal approaches (EEA) to pituitary adenoma resection. In 2018, we published the first ever flap risk score (FRS) to predict the use of NSF. We present here a validity study examining the FRS as applied to our center.

Methods: A retrospective review was completed of consecutive patients undergoing EEA from January 2015 to March 2021. The sensitivity, specificity, and predictive value of the FRS were calculated. A multivariate logistic model was used to determine the relative weight imaging characteristics in predicting need for NSF. The relative weighting of the FRS was then re-optimized.

Results: A total of 376 patients underwent EEA for pituitary adenoma resection, with 113 (30.1%) requiring NSF. The FRS had a sensitivity and specificity of 43.4% and 94.7%, respectively. Sphenoid sinus extension increased the odds of needing a NSF equivalent to 19 mm of tumor height, as opposed to 6 mm in the original 2018 cohort. The re-optimized model had sensitivity and specificity of 79.6% and 76.4%, respectively.

Conclusion: We present a validity study examining the utility of FRS in predicting the use of NSF after EEA for pituitary adenoma resection. Our results show that while FRS is still predictive of the need for NSF after EEA, it is not as predictive now as it was for its original cohort. Therefore, a more comprehensive model is necessary to more accurately stratify patients' preoperative risk for NSF.

Keywords: Endoscopic endonasal surgery; Nasoseptal flap; Pituitary adenoma; Transsphenoidal surgery; Validity.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
ROC curve for the original FRS applied to the validation cohort.
Fig. 2
Fig. 2
ROC curve for the re-optimized FRS applied to the validation cohort.
See this image and copyright information in PMC

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