Assessment of post-operative healing following endoscopic, transnasal, transsphenoidal pituitary surgery without formal sellar grafting☆
Author links open overlay panelDannyJandaliaSarahShearerbRichardByrnecdPeterPapagiannopoulosaBobby A.TajudeenadPete S.Batraad
a
Department of Otorhinolaryngology – Head and Neck Surgery, Rush Medical College, Chicago, IL, United States of America
b
Rush Medical College, Chicago, IL, United States of America
c
Department of Neurosurgery, Rush University Medical Center, Chicago, IL, United States of America
d
Rush Center of Skull Base and Pituitary Surgery, Rush University Medical Center, Chicago, IL, United States of America
Received 15 August 2019, Available online 29 October 2019.
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https://doi.org/10.1016/j.amjoto.2019.102306Get rights and content
Abstract
Introduction
Multiple options exist for sellar reconstruction after endoscopic transnasal, transsphenoidal surgery (TSS) including free mucosa, fat, bone and synthetic materials. The objective of this study was to assess healing and mucosalization of the sellar face following TSS without formal sellar grafting or reconstruction.
Methods
Single institution retrospective chart review was conducted for patients undergoing TSS without intraoperative CSF leaks between January 2014 and March 2017 at Rush University Medical Center. No formal sellar reconstruction was performed for the entire patient group. Follow-up endoscopic data and clinical notes were coded for time to mucosalization of the sella as well as degree of abnormal mucosal healing, epistaxis, crusting and scarring.
Results
83 patients were included in this study. Mean time to mucosalization was 119 days (range, 17 to 402 days). Incidence of abnormal mucosal healing, epistaxis, crusting and scarring increased from the first to the second postoperative visit but trended down by the third visit. Nasal crusting was the most common finding, followed by abnormal mucosal healing. Chi square analysis showed smoking to be associated with prolonged time to full mucosalization of the sella. Two patients (2.4%) had post-operative CSF leaks requiring lumbar drain placement.
Conclusion
Adequate sellar healing is achievable in all cases without formal grafting or reconstruction after TSS. Great care must be exercised given the small inherent risk of unmasking a subclinical intraoperative CSF leak. Patients should be followed closely endoscopically during the first four months after TSS to minimize the impact of crusting.
Keywords
Pituitary adenomaEndoscopic surgeryMinimally invasive surgeryCerebrospinal fluid leakSellaReconstruction
☆
Part of this work was presented at the Annual ARS meeting on September 8, 2017 in Chicago, Illinois.
View full text
© 2019 Published by Elsevier Inc.
Author links open overlay panelDannyJandaliaSarahShearerbRichardByrnecdPeterPapagiannopoulosaBobby A.TajudeenadPete S.Batraad
a
Department of Otorhinolaryngology – Head and Neck Surgery, Rush Medical College, Chicago, IL, United States of America
b
Rush Medical College, Chicago, IL, United States of America
c
Department of Neurosurgery, Rush University Medical Center, Chicago, IL, United States of America
d
Rush Center of Skull Base and Pituitary Surgery, Rush University Medical Center, Chicago, IL, United States of America
Received 15 August 2019, Available online 29 October 2019.
Show less
https://doi.org/10.1016/j.amjoto.2019.102306Get rights and content
Abstract
Introduction
Multiple options exist for sellar reconstruction after endoscopic transnasal, transsphenoidal surgery (TSS) including free mucosa, fat, bone and synthetic materials. The objective of this study was to assess healing and mucosalization of the sellar face following TSS without formal sellar grafting or reconstruction.
Methods
Single institution retrospective chart review was conducted for patients undergoing TSS without intraoperative CSF leaks between January 2014 and March 2017 at Rush University Medical Center. No formal sellar reconstruction was performed for the entire patient group. Follow-up endoscopic data and clinical notes were coded for time to mucosalization of the sella as well as degree of abnormal mucosal healing, epistaxis, crusting and scarring.
Results
83 patients were included in this study. Mean time to mucosalization was 119 days (range, 17 to 402 days). Incidence of abnormal mucosal healing, epistaxis, crusting and scarring increased from the first to the second postoperative visit but trended down by the third visit. Nasal crusting was the most common finding, followed by abnormal mucosal healing. Chi square analysis showed smoking to be associated with prolonged time to full mucosalization of the sella. Two patients (2.4%) had post-operative CSF leaks requiring lumbar drain placement.
Conclusion
Adequate sellar healing is achievable in all cases without formal grafting or reconstruction after TSS. Great care must be exercised given the small inherent risk of unmasking a subclinical intraoperative CSF leak. Patients should be followed closely endoscopically during the first four months after TSS to minimize the impact of crusting.
Keywords
Pituitary adenomaEndoscopic surgeryMinimally invasive surgeryCerebrospinal fluid leakSellaReconstruction
☆
Part of this work was presented at the Annual ARS meeting on September 8, 2017 in Chicago, Illinois.
View full text
© 2019 Published by Elsevier Inc.
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