open access
Multi-layer reconstruction of skull base after endoscopic transnasal surgery for invasive pituitary adenomas
Affiliations- Department of Neurosurgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, Shandong, China
- Department of Neurosurgery, The First People’s Hospital of Ningyang County, Taian, Shandong, China
open access
Abstract
Objective. To explore the efficacy of multi-layer skull base reconstruction after endoscopic transnasal surgery for invasive pituitary adenomas (IPAs).
Clinical rationale for the study. Skull base reconstruction for IPAs.
Material and methods. This retrospective analysis involved 160 patients with IPAs who underwent operations from October 2018 to October 2020. All patients were diagnosed with IPAs by pituitary enhanced magnetic resonance imaging, and all tumours were confirmed to be Knosp grades 3a, 3b, or 4. The experimental group and the control group comprised 80 patients in each, and we used different methods to reconstruct the skull base in each group. The comparison indicators included cerebrospinal fluid leakage, sellar floor bone flap (or middle turbinate) shifting, delayed healing of the skull base reconstructed tissue, nasal discomfort, and epistaxis. We used the chi-square test, and p < 0.05 was considered statistically significant.
Results. In the experimental group, cerebrospinal fluid leakage occurred intraoperatively in 73 patients, two of whom had cerebrospinal fluid leakage postoperatively. Brain CT 12 months postoperatively showed no sellar floor bone flap (or middle turbinate) shifting. Endoscopic transnasal checks performed seven days after surgery showed that the skull base reconstructed tissue had healed in 74 patients and had failed to heal in six. However, endoscopic transnasal checks showed that all six of these patients’ pedicled nasoseptal flaps had healed well by 14 days after surgery. Other sequelae comprised nasal discomfort in four patients, and epistaxis in four. In the control group, cerebrospinal fluid leakage occurred intraoperatively in 71 patients, 14 of whom had cerebrospinal fluid leakage postoperatively. Brain CT 12 months postoperatively showed floor bone flap (or middle turbinate) shifting in 12 patients. Endoscopic transnasal checks performed seven days after surgery showed that the skull base reconstructed tissue had healed in 65 patients. In 12 patients, pedicled nasoseptal flaps had healed well by 14 days after surgery, while the remaining three patients required reoperation. Other sequelae comprised nasal discomfort in five patients, and epistaxis in six.
Conclusions. This new method of multi-layer skull base reconstruction could play an important role in endoscopic transnasal IPA surgery.
Abstract
Objective. To explore the efficacy of multi-layer skull base reconstruction after endoscopic transnasal surgery for invasive pituitary adenomas (IPAs).
Clinical rationale for the study. Skull base reconstruction for IPAs.
Material and methods. This retrospective analysis involved 160 patients with IPAs who underwent operations from October 2018 to October 2020. All patients were diagnosed with IPAs by pituitary enhanced magnetic resonance imaging, and all tumours were confirmed to be Knosp grades 3a, 3b, or 4. The experimental group and the control group comprised 80 patients in each, and we used different methods to reconstruct the skull base in each group. The comparison indicators included cerebrospinal fluid leakage, sellar floor bone flap (or middle turbinate) shifting, delayed healing of the skull base reconstructed tissue, nasal discomfort, and epistaxis. We used the chi-square test, and p < 0.05 was considered statistically significant.
Results. In the experimental group, cerebrospinal fluid leakage occurred intraoperatively in 73 patients, two of whom had cerebrospinal fluid leakage postoperatively. Brain CT 12 months postoperatively showed no sellar floor bone flap (or middle turbinate) shifting. Endoscopic transnasal checks performed seven days after surgery showed that the skull base reconstructed tissue had healed in 74 patients and had failed to heal in six. However, endoscopic transnasal checks showed that all six of these patients’ pedicled nasoseptal flaps had healed well by 14 days after surgery. Other sequelae comprised nasal discomfort in four patients, and epistaxis in four. In the control group, cerebrospinal fluid leakage occurred intraoperatively in 71 patients, 14 of whom had cerebrospinal fluid leakage postoperatively. Brain CT 12 months postoperatively showed floor bone flap (or middle turbinate) shifting in 12 patients. Endoscopic transnasal checks performed seven days after surgery showed that the skull base reconstructed tissue had healed in 65 patients. In 12 patients, pedicled nasoseptal flaps had healed well by 14 days after surgery, while the remaining three patients required reoperation. Other sequelae comprised nasal discomfort in five patients, and epistaxis in six.
Conclusions. This new method of multi-layer skull base reconstruction could play an important role in endoscopic transnasal IPA surgery.
Keywords
invasive pituitary adenoma, Knosp classification, multiple layers of materials, skull base reconstruction
About this articleTitle
Multi-layer reconstruction of skull base after endoscopic transnasal surgery for invasive pituitary adenomas
Journal
Neurologia i Neurochirurgia Polska
Issue
Article type
Review Article
Pages
160-168
Published online
2022-12-29
Page views
2129
Article views/downloads
510
DOI
Pubmed
Bibliographic record
Neurol Neurochir Pol 2023;57(2):160-168.
Keywords
invasive pituitary adenoma
Knosp classification
multiple layers of materials
skull base reconstruction
Authors
Mengyang Xing
Wenming Lv
Pengfei Liu
Jing Wang
Wenbo Gao
Yongqiang Xu
Zhuoqun Li
Liangwen Zhang
References (10)- Jefferson G. Extrasellar extensions of pituitary adenomas: (section of neurology). Proc R Soc Med. 1940; 33(7): 433–458.
- Knosp E, Steiner E, Kitz K, et al. Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery. 1993; 33(4): 610–7; discussion 617.
- Low CM, Vigo V, Fernández-Miranda JC, et al. Anatomic considerations in endoscopic pituitary surgery. Otolaryngol Clin North Am. 2022; 55(2): 223–232.
- Truong HQ, Lieber S, Najera E, et al. The medial wall of the cavernous sinus. Part 1: Surgical anatomy, ligaments, and surgical technique for its mobilization and/or resection. J Neurosurg. 2018; 131(1): 122–130.
- Esposito F, Dusick J, Fatemi N, et al. Graded repair of cranial base defects and cerebrospinal fluid leaks in trans sphenoidal surgery. Oper Neurosurg. 2007; 60(4): 295–304.
- Li Z, Ji T, Huang GD, et al. A stratified algorithm for skull base reconstruction with endoscopic endonasal approach. J Craniofac Surg. 2018; 29(1): 193–198.
- Nishizawa T, Ochiai Y, Uraoka T, et al. Endoscopic slip-knot clip suturing method: prospective pilot study (with video). Gastrointest Endosc. 2017; 85(2): 433–437.
- Xing M, Lv W, Wang J, et al. Sellar floor bone flap with a pedicled nasoseptal flap in endoscopic transnasal pituitary adenoma surgery. J Craniofac Surg. 2021; 32(2): e191–e195.
- Lee SH, Sim SH, Ki SH. Low-temperature burn on replanted fingers and free flaps in hand. Ann Plast Surg. 2018; 81(4): 402–406.
- Hadad G, Bassagasteguy L, Carrau R, et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. The Laryngoscope. 2006; 116(10): 1882–1886.
