Minimizing Morbidity in Endoscopic Pituitary Surgery: Outcomes of the Novel Nasoseptal Rescue Flap Technique

Objective. The novel nasoseptal rescue flap has been proven to provide complete coverage of dural defects that may be encountered during endoscopic pituitary surgery through cadaveric studies. In this case series, the authors report outcomes from the first cohort of patients who had a nasoseptal rescue flap raised prior to surgery. Study Design. Case series with chart review. Setting. University of North Carolina-Chapel Hill. Subjects and Methods. Patients requiring nasoseptal rescue flaps were identified from the senior author's database. Results. Nasoseptal rescue flaps were harvested in 26 consecutive patients, with only 7 (27%) patients actually requiring use of the rescue flap for skull base reconstruction due to intraoperative cerebrospinal fluid (CSF) leak. Six patients had low-flow CSF leaks, whereas 1 patient had a high-flow CSF leak. Nineteen patients had pituitary adenomas, whereas 7 patients had Rathke cleft cyst. Mean follow-up time was 6 months (range, 1-16 months). Since surgery, no patients have presented with CSF leak or septal perforation. The success rate in those 7 patients with rescue flap utilization was 100%. Conclusion. The nasoseptal rescue flap is an effective surgical technique for patients undergoing pituitary surgery without a planned nasoseptal flap. It allows for vascularized skull base reconstruction if an intraoperative CSF leak is encountered and minimizes donor site morbidity if a leak is not encountered.