Gode Sercan, Biceroglu Huseyin, Turhal Goksel, Erdogan Umut, Ates Murat S, Kaya Isa, Ozgiray Erkin, Midilli Rasit, Karci Bulent
Otolaryngology Department, Ege University School of Medicine, 35100, Bornova, Izmir, Turkey.
Neurosurgery Department, Ege University School of Medicine, 35100, Bornova, Izmir, Turkey.
Eur Arch Otorhinolaryngol. 2017 Feb;274(2):897-900. doi: 10.1007/s00405-016-4314-9. Epub 2016 Sep 28.
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.
鼻内镜下经鼻入路已成功用于垂体瘤的治疗；然而，鼻中隔黏膜的缺失，尤其是在蝶筛隐窝和鼻中隔后部周围，可能是该技术的一个缺点。本研究的目的是描述一种鼻内镜经蝶垂体手术中鼻内入路的变体，即“双鼻中隔瓣”技术，并评估其效果。该技术依赖于一侧完全切取较大的鼻中隔瓣，另一侧切取较小的鼻中隔瓣。纳入了30例患者。通过术前和术后第一个月的视觉模拟评分（VAS）评估功能结果，通过从蝶窦开口到鼻小柱实现完整的鼻中隔来评估形态。还评估了蝶窦炎、蝶筛隐窝粘连和结痂的情况。术前和术后的平均VAS分别为71和67毫米（p>0.01）。术后无鼻中隔穿孔、粘连和蝶窦炎。3例患者（10%）在术后第一个月蝶筛隐窝有结痂。双鼻中隔瓣技术具有手术中暴露更广泛等优点；如有需要可使用制备好的瓣，术后形态和功能效果更好。该技术安全，无任何穿孔且结痂最少。
