Reconstruction of Sphenoid Defects: Lateral Recess, Sellar, Tuberculum, and Planum Defects

Abstract

Endoscopic skull base surgery continues to rapidly evolve, requiring comparable advances in skull base reconstructive techniques. In the era of advanced endoscopic techniques, skull base reconstruction involving the sphenoid sinus has become critical given the wide variety of pathology treated. Traditionally, this began with standard pituitary surgery that required the reconstruction of small sellar defects. This advanced to larger intracranial pathology, such as meningiomas and craniopharyngiomas, which left the reconstructive surgeon with larger, high-flow cerebrospinal fluid (CSF) leak reconstructions. Finally, we have also seen the advance of strictly endonasal closure for CSF leaks related to idiopathic intracranial hypertension (IIH) that requires key differences in reconstruction. Nevertheless, the key tenets of sphenoid sinus CSF leak reconstruction remain the same—multilayer reconstruction of the skull base defect. When considering reconstruction, consider the sphenoid mucosal layer, the skull base bone, and the dura as three distinct layers. As long as two of these three layers are adequately reconstructed, there will be minimal reconstructive failure. As the reconstruction techniques have evolved from free tissue grafts to local and regional tissue flaps, the postoperative CSF leak rates have decreased to less than 5%.