Medical Faculty, Otorhinolaryngology Clinic.
Medical Faculty, Neurosurgery Clinic, Afyon Health Sciences University, Afyonkarahisar, Turkey.
J Craniofac Surg. 2021;32(2):e208-e211. doi: 10.1097/SCS.0000000000006800.
Endoscopic endonasal approach has become popularly preferred for pituitary surgery in recent years. In this study we described a new technique which is developed by the first author and which is modified from The Rivera-Serrano "salvage" flap approach. With this new technique the septum morbidity was completely prevented and a wider and more comfortable vision was provided for the operation.
This study consists 7 patients who underwent endoscopic endonasal transsphenoidal pituitary surgery (EETPS) with the described technique (modified salvage flap technique) between 2017 and 2019 and 13 patients underwent EETPS using salvage flap technique. The follow-up period was at least 6 months (24-6 months) for septal integrity.
Intraoperative septum integrity was observed in all 7 patients who were treated with modified rescue flap technique. In 9 of 13 patients who had salvage flap technique, intraoperative septum posterior defects were observed. In postoperative follow-up (min postop 3 months), endoscopic examination showed no septal perforation in 6 patients who were treated with modified rescue flap technique, and 1 patient had 2 × 2 mm perforation posteriorly. In postoperative endoscopic follow-up of 13 patients who underwent salvage flap technique (min postop 3 months), 4 patients had complete septal integrity, while 9 patients had different sizes of posterior septal perforation.
According to other described approach techniques, our modification using a pedicle and septum protective-transposition technique provides improved access to the downstream side of the sphenoid sinus and clivus, allowing the pedicle to slide down and take a more horizontal position. The improved maneuverability of the pedicle created in the case of cerebrospinal fluid leakage as a complication also allows it to be used as a bilateral wing to cover the exposed bone. We think that this technique is the best method to be used for EETPS with modified saline flap technique.
近年来，内镜经鼻入路已成为垂体手术的首选方法。本研究介绍了一种新技术，由第一作者开发，并对 Rivera-Serrano 的“抢救”皮瓣入路进行了改良。通过这种新技术，可以完全避免鼻中隔的损伤，并为手术提供更宽、更舒适的视野。
本研究纳入了 7 例 2017 年至 2019 年间采用描述技术（改良抢救皮瓣技术）行内镜经鼻蝶垂体手术（EETPS）的患者，以及 13 例采用抢救皮瓣技术行 EETPS 的患者。鼻中隔完整性的随访时间至少为 6 个月（24-6 个月）。
在采用改良抢救皮瓣技术的 7 例患者中，术中鼻中隔完整。在采用抢救皮瓣技术的 13 例患者中，9 例术中发现鼻中隔后缘缺损。术后 3 个月以上内镜随访显示，采用改良抢救皮瓣技术的 6 例患者无鼻中隔穿孔，1 例患者后缘有 2×2mm 穿孔。在采用抢救皮瓣技术的 13 例患者术后 3 个月以上的内镜随访中，4 例患者鼻中隔完整，9 例患者后缘有不同大小的鼻中隔穿孔。
与其他描述的手术技术相比，我们采用带蒂和鼻中隔保护转位技术的改良方法，提供了对蝶窦和斜坡下游侧的更好的进入，使蒂能够向下滑动并采取更水平的位置。在发生脑脊液漏等并发症时，由于 pedicle 具有更好的可操作性，也可以将其作为双翼覆盖暴露的骨面。我们认为，对于采用改良盐水皮瓣技术的 EETPS，这种技术是最好的方法。
