Study of the nasoseptal flap for endoscopic skull base reconstruction of the sellar defect

Abstract

The nasoseptal flap for endoscopic reconstruction of the skull base was essential in the development of endonasal surgery into the cranial cavity. The endonasal pituitary surgery is the most often performed. If CSF fistula occur, its closure is required. Although not always necessary, the nasoseptal flap (pedicled in septal artery) is the most consistent reconstruction. However, it should be prepared at the beginning of the surgery, before knowing the defect dimensions. Objective: to evaluate the relation between the dimensions of the pedicle and reconstructive portion of the nasoseptal flap that should be prepared to occlude the defect after wide opening of the sella in pituitary surgery, in CT scan. Methods: prospective analysis of 40 CT scans of normal individuals (20 with sellar type of sphenoidal sinus and 20 with presellar type) in axial plane and sagittal reconstruction. The maximum access to the sella turcica in transverse (inter-cavernous distance) and longitudinal direction (height of the sella turcica) will be measured. The distance from the sphenopalatine forame (origin of the nasoseptal flapt) to the sellar defect edge (pedicle portion of the flap) will be obtained. Then, it will be drawn on the sagittal CT scan (septum view) the recommended flap to cover the sellar defect, considering both the pedicle and reconstructive portions. The dimensions of the total flat, the pedicle and the reconstructive portions will be correlated. (AU)