Utility of sphenoid mucosal flaps in transnasal transsphenoidal surgery

CONCLUSIONS: Use of a sphenoid mucosal flap in transsphenoidal surgery decreased the incidence of postoperative cerebrospinal fluid (CSF) leaks and promoted wound healing of the sphenoid sinus. OBJECTIVES: To evaluate the effectiveness of sphenoid mucosal flaps for the reconstruction of the sellar floor after transsphenoidal surgery. PATIENTS AND METHODS: Patients who underwent transnasal transsphenoidal surgery were reviewed. Data on materials used for the sellar reconstruction, presence of postoperative CSF leaks, duration of lumbar drainage and local wound complications of the sphenoid sinus were collected. RESULTS: Sphenoid mucosal flaps were used in 46 cases but not in 22 cases. An intersinus septal mucosal flap was most commonly used. Total mucosal covering was possible in 43 cases, partial covering in 3 cases and no covering in 22 cases. Postoperative CSF leaks occurred exclusively in six patients with partial or no mucosal covering. The duration of lumbar drainage was shorter in patients with a total mucosal covering than in those with a partial or no mucosal covering (average 4.3 days vs 11.7 days, p=0.003). Local wound complications of the sphenoid sinus occurred more frequently in patients with no mucosal covering than in patients with a mucosal covering (5/22, 22.7% vs 1/46, 2.1%, respectively, p=0.012).