Endoscopic Sellar Floor Reconstruction with Concha Bullosa Bone Autograft and Nasal Septal Flap: Technical Case Report

Introduction: A novel method is introduced for sellar floor reconstruction after expanded endoscopic endonasal transsphenoidal surgery using concha bullosa bone autograft and vascularized, posteriorly based flaps of septal mucoperichondrium. Case Report: A 62-year-old woman presented to her primary care physician with the insidious onset of enlarging hands and feet, coarsening of facial features, and bilateral carpal tunnel syndrome. Endocrine studies revealed elevated growth hormone (22 ng/mL) and somatomedian-C (810 ng/mL) levels. Brain magnetic resonance imaging displayed a 1.2-cm pituitary adenoma. The patient was diagnosed with acromegaly secondary to a pituitary adenoma and underwent expanded endoscopic endonasal transsphenoidal surgery for tumor resection. Preoperatively, the patient was noted to have abnormal right middle turbinate pneumatization (concha bullosa). Following adenoma resection, the sellar floor was reconstructed using concha bullosa bone autograft resected during the endonasal approach. Bilateral vascularized nasoseptal mucosal flaps were then placed over the sellar floor. Conclusion: In patients with concha bullosa, conchal bone provides a useful substrate for sellar reconstruction after endoscopic endonasal transsphenoidal surgery.