Abstract
Objectives
This study aimed to better learn how pituitary surgery centers around the world perform
the reconstruction step of endoscopic endonasal transsphenoidal pituitary surgery
and to understand the rationale behind their strategies.
Design
Survey.
Setting and Participants
Representatives of 311 centers across 54 countries were invited.
Main Outcome Measures
Online 15-question questionnaire.
Results
Representatives of 121 centers from 36 countries responded to the survey. We recorded
a preference for multilayer reconstruction in all scenarios presented. In cases of
intraoperative cerebrospinal fluid (CSF) leak and extended approaches, respondents
reported greater use of autologous materials, such as fat grafts, fascia lata, and
pedicled flaps. Although there was no statistical significance for most of the scenarios
analyzed, we observed a greater tendency to use pedicled flaps in centers with ENT
specialists on the team and a lower likelihood of using them in centers with a higher
surgical volume. For cases where no CSF leak is expected preoperatively, the overall
preference was for the use of rescue flaps (56.10%), especially in centers in which
an ENT surgeon was present (69.77%). Once a nasoseptal flap has been created, the
preference is for the nasal septum to heal by secondary intention (52.23%).
Conclusion
This survey provides additional evidence of the wide variability in practice and strategies
among specialized pituitary/skull base surgery centers worldwide. Trends toward multilayer
reconstruction, use of the nasoseptal flaps, and autologous grafts were observed.
The presence of an otolaryngologist on the team influences the reconstruction strategy
adopted at the institution.
Keywords
pituitary adenoma - endoscopic transsphenoidal surgery - skull base surgery - skull
base reconstruction - survey
