Endoscopic endonasal approach has been successfully used for the management of pituitary tumors; however, the loss of septal mucosa especially around sphenoethmoidal recess and posterior nasal septum might be a disadvantage of this technique. The aim of this study is to describe a variation of the endonasal approach, “double nasoseptal flap” technique in endoscopic transsphenoidal pituitary surgery, and to evaluate its outcomes. The technique depends on fully harvested bigger nasoseptal flap on one side and smaller on the other. Thirty patients were included. Functional results were assessed by preoperative and postoperative first month visual analogue scale (VAS), and morphology was evaluated by achieving intact septum from the sphenoid ostium to the columella. Sphenoid sinusitis, the presence of synechia and crusting in the sphenoethmoidal recess was also assessed. Mean VAS was 71 and 67 mm preoperatively and postoperatively, respectively (p > 0.01). There were no septal perforations, synechia, and sphenoid sinusitis postoperatively. Three patients had (10 %) crusts on sphenoethmoidal recess on first month postoperatively. Double nasoseptal flap technique has advantages, such as wider exposure during surgery; prepared flaps could be used if needed, better morphological and functional outcomes postoperatively. The technique is safe without any perforations and minimal crusting.
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Conflict of interest
None of the authors has declared any conflict of interest (financial or non-financial) from being named as an author on the manuscript.
Informed consent was obtained from all individual participants included in the study.
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Video 1: Nasoseptal flap incisions are followed by en bloc removal of the cartilaginous septum. Three layered appearance is shown with an elevator. The right nasoseptal flap is sutured to the remaining cartilage. The septum is total reconstructed, and the left nasoseptal flap is sutured in position. The left and right nasal cavities are shown after suturing (MP4 53963 kb)
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Gode, S., Biceroglu, H., Turhal, G. et al. Double nasoseptal flap technique for endonasal pituitary surgery. Eur Arch Otorhinolaryngol 274, 897–900 (2017) doi:10.1007/s00405-016-4314-9
- Endoscopic endonasal approach
- Nasoseptal flap
- Cranial base
- Skull base