Bilateral Modified Nasoseptal "Rescue" Flaps in the Endoscopic Endonasal Transsphenoidal Approach

Objectives/HypothesisFor a wide exposure of skull base and preservation of septal mucosa, we have raised bilateral modified nasoseptal rescue flaps in the endoscopic endonasal transsphenoidal approach (EETSA) and evaluated the usefulness of these flaps elevation. Study DesignCase series. MethodsThe study population comprised the patients who underwent EETSA with bilateral modified nasoseptal rescue flaps elevation between February 2009 and June 2012. We retrospectively reviewed patients' medical records. Patients underwent preoperative nasal evaluation using the Nasal Obstruction Symptom Evaluation (NOSE), Sino-Nasal Outcome Test (SNOT-20), and a visual analogue scale (VAS) to assess several nasal symptoms. Repeat testing was performed 6 months postoperatively. ResultsA total of 92 patients underwent the EETSA with bilateral modified nasoseptal rescue flaps elevation. A total of 17 patients had intraoperative cerebrospinal fluid (CSF) leakage. Three patients underwent extension of the modified nasoseptal rescue flap to a conventional nasoseptal flap. No patients underwent reoperation due to CSF leakage. There was no statistical difference between preoperative and postoperative total SNOT-20 and NOSE scores. According to the VAS, subjective olfaction function statistically worsened (P=0.011) postoperatively. ConclusionBilateral modified nasoseptal rescue flaps elevation provided good exposure of the sellar floor, preserved the septal branch of sphenopalatine artery, and facilitated removal of sellar tumors. We could also preserve more septal mucosa by designing a novel incision and repositioning unused flaps to their original sites. Postoperative complications of the nasal cavity were thus minimized. We believe that this flap is very useful in a variety of settings during the EETSA.