| Objectives:Bilateral posterior nasoseptal flaps are a new reconstructive technique.This study aimed to verify the reliability and safety of this technique for skull base reconstruction during endoscopic transnasal surgery for pituitary adenomas.Methods:We retrospectively analyzed the data of 264 patients who underwent endoscopic transnasal surgery for pituitary adenomas at the our center from January,2021 to June,2022.161 patients who met the requirements were screened according to the inclusion and exclusion criteria and divided into the bilateral posterior nasoseptal mucosal flap(mucosal flap group)and conventional free graft multiple skull base reconstruction group(conventional reconstruction group).The differences in operation time,hospital stay,postoperative cerebrospinal fluid(CSF)leakage,nasal bleeding,long-term nasal crusting,ASK Nasal Inventory-12 questionnaire(ASK Nasal Inventory-12),and visual analogue scale(VAS)score of olfaction were compared between the two groups.Univariate and multifactorial Logistic regression analyses demonstrated that bilateral posterior nasoseptal flaps were a protective factor for postoperative CSF leakage.The Spearman’s correlation analysis was performed to investigate the population that was not suitable for skull base reconstruction using this mucosal flap.Results:Of the 161 patients who met the inclusion criteria,77 were in the mucosal flap group,and 84 were in the conventional reconstruction group.There were no significant differences in baseline characteristics between the two groups(P>0.05).One person in the mucosal flap group had postoperative CSF leakage(1.3%),ten people in the conventional reconstruction group had CSF leakage(11.9%),and the difference was statistically significant(P<0.05).The median operation time was 140(125,170)min in the mucosal flap group and 140(115,180)min in the conventional reconstruction group,with no significant difference in the overall operation time between the two groups(P>0.05).The median hospital stay was 11(10,14)days in the mucosal flap group and 11(9,15)days in the conventional reconstruction group,with no significant difference in the overall hospital stay between the two groups(P>0.05).In the mucosal flap group,9 people had nasal bleeding(11.7%),and 11 people had nasal bleeding(13.1%)in the conventional reconstruction group,and the difference in the incidence of nasal bleeding was not statistically significant(P>0.05).In this study,5 people in the mucosal flap group still had nasal crusting symptoms(6.5%),and 4 people in the conventional reconstruction group currently had nasal crusting symptoms(4.8%).There was no significant difference in the incidence of long-term crusting between the two groups(P>0.05).The median ASK Nasal Inventory-12 score was 3(0,7)in the mucosal flap group and 3(0,5)in the conventional reconstruction group.A total of 27 patients(35.1%)in the mucosal flap group had varying degrees of residual olfactory hyposmia and a median olfactory VAS score of 0(0,2);33 patients in the conventional reconstruction group(39.3%)had varying degrees of olfactory hyposmia,with a median olfactory VAS score of 0(0,2)points.There was no significant difference in the proportion of olfactory hyposmia and VAS score distribution between the two groups(P>0.05).Univariate and multifactorial Logistic regression analyses showed that intraoperative CSF leakage was an independent risk factor for postoperative CSF leakage(odds ratio[OR]=10.504 P<0.05),and the use of bilateral posterior nasoseptal flaps was a protective factor for postoperative CSF leakage(OR=0.092 P<0.05).The Spearman’s correlation analysis of quality of life(QoL)did not reveal the factors that affected the long-term postoperative QoL of patients.Conclusion:Bilateral posterior nasoseptal flaps are a reliable technique of skull base reconstruction that can effectively reduce the incidence of postoperative CSF leakage.In addition,this technique has no significant adverse effects on the duration of surgery and hospitalization,complication rate,and long-term QoL of patients. |
