Department of Neurosurgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences.
Department of Intensive Care Unit of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, China.
J Craniofac Surg. 2021;32(5):1898-1900. doi: 10.1097/SCS.0000000000007621.
Nasoseptal rescue flap (NSRF), which preserves the pedicle of the flap and is harvested as a nasoseptal flap (NSF) when intraoperative leakage of cerebrospinal fluid (CSF) occurs, is an alternative strategy for skull base reconstruction in patients with pituitary adenoma resection via an endoscopic endonasal approach. However, in practice, the original NSRF technique cannot meet the needs during operation. Therefore, the authors aimed to describe a modified NSRF technique for the resection of pituitary adenoma via endoscopic endonasal approach and to examine its utility and outcomes. The authors retrospectively analyzed the medical records of 87 consecutive patients with pituitary adenoma who underwent endoscopic endonasal surgery performed using NSRF technique from September 2019 to August 2020. Data on intraoperative CSF leakage, NSF conversion rate, and reconstruction-related complications were analyzed. The average age of patients was 50.1 years (men, 50.5%). Twenty-five cases of intraoperative CSF leakage were observed: 23 cases of low-flow CSF leakage and two cases of high-flow CSF leakage. NSRF was converted to NSF in 11 cases. Two patients experienced postoperative CSF leakage after reconstruction without NSF and required unplanned reoperation to rebuild the skull base with NSF. In conclusion, this modified NSRF utilized a minimally invasive way to provide sufficient surgical corridor without the need for pedicle retraction, and it can be effectively converted to an NSF for skull base reconstruction in patients with pituitary adenoma.
鼻内鼻中隔救援皮瓣（NSRF）保留了皮瓣的蒂，并且当术中发生脑脊液（CSF）泄漏时被作为鼻内鼻中隔皮瓣（NSF）收获，这是经鼻内镜颅底重建的替代策略在经内镜经鼻入路切除垂体腺瘤的患者中。然而，在实践中，原始的 NSRF 技术无法满足手术中的需求。因此，作者旨在描述一种改良的经鼻内镜 NSRF 技术用于经内镜经鼻入路切除垂体腺瘤，并检查其效用和结果。作者回顾性分析了 2019 年 9 月至 2020 年 8 月期间使用 NSRF 技术经内镜经鼻手术的 87 例连续垂体腺瘤患者的病历。分析了术中 CSF 漏、NSF 转化率和重建相关并发症的数据。患者的平均年龄为 50.1 岁（男性 50.5%）。观察到 25 例术中 CSF 漏：23 例低流量 CSF 漏和 2 例高流量 CSF 漏。11 例 NSRF 转换为 NSF。2 例重建后发生术后 CSF 漏，无 NSF，需要非计划再次手术用 NSF 重建颅底。总之，这种改良的 NSRF 采用微创方式提供了充足的手术通道，无需蒂部牵拉，并且可以有效地转换为 NSF 用于垂体腺瘤患者的颅底重建。
