Purely Nasal Floor Mucosa Free Graft for EEA Transellar Postoperative Defects

Introduction: Ongoing developments in reconstructive strategies continue to improve the safety and efficacy of endoscopic endonasal approaches (EEA) to the skull base. Implementation of mucoperichondrium free grafts from the nasal cavity has proven useful to reconstruct defects created during most non-extended EEA to the ventral skull base. In this radioanatomical study with clinical correlate, we study the purely nasal floor mucosa (PuNFM) free-graft.

Objective:

- To evaluate the coverage surface area provided by the PuNFM, study the adequacy of the PuNFM in the reconstruction of EEA transellar postoperative defects.

- To compare and evaluate this technique with current sellar region reconstruction practices.

Method: A full step-by-step nasal floor free mucosal graft for EEA assisted by neuronavigation was harvested in five cadaveric specimens (10 nasal fossae) and the area provided for reconstruction was calculated. Twenty-five consecutive cases of pituitary adenomas resected through an EEA were analyzed to estimate the sellar defect surface area (SDSA) after a transellar EEA and calculate the area of PuNFM bilaterally.

Result: The median cadaveric SDSA was 4.77 cm². Clinically, the median SDSA was 5.36 cm², and the total radiological PuNFM surface area was 5.46 cm², with modified Knosp grade >2 tumors having larger SDSA than that of Knosp grade <2 tumors. The PuNFM graft proved to be most effective for covering modified Knosp <2 tumor defects. The nasal floor-free graft offered several advantages. First, it represents a simple and quick technique. Second, it minimizes anatomical and functional disruption of the nasal fossa. Third, it offers enough surface to cover most of the defects created in non-extended ventral skull base EEA. Lastly, it is a more cost-effective alternative to synthetic duraplasty.

Conclusion: The PuNFM represents a fast and simple technical solution that provides sufficient surface area to reconstruct the majority of the sellar defects related to transellar EAA for pituitary adenomas. This technique may positively impact sinonasal function and quality of life.

Publikationsverlauf

Artikel online veröffentlicht:
15. Februar 2022