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Sellar Reconstruction Post Endonasal Pituitary Surgeries: Case Series with Our Protocol


Author: Tunjai Namiq Faiq, Ozdan Akram Ghareeb*, Saman Fadhil Jamal, Mahmood Sami
Department of Pharmacy, Northern Technical University, Iraq.
Published Date: 2024-04-14
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Keywords: Sella turcica, endonasal reconstruction, transsphenoidal surgery.
Abstract:
Sella turcica is a bony depression situated on the intracranial surface of the sphenoid bone, and in order to prevent the postoperative leakage of cerebrospinal fluid (CSF) during transsphenoidal surgery, it is crucial to undergo complete sellar floor reconstruction. This study aimed to evaluate the effectiveness of endonasal reconstruction of the sella turcica to prevent CSF leakage. This study included a case series of (83) patients admitted to Kirkuk Teaching Hospital in northern Iraq, from the period (2015) to (2021), and they underwent endoscopic transsphenoidal approach by performing rescue flap bilaterally with preserving the blood supply in all cases. This was followed by evaluation of intraoperative cerebrospinal fluid leak according to Daniel F. Kelly classification of graded repair protocol with some of our necessary modifications to obtain the best outcome. The results confirmed that out of a total of 83 cases, the most common pathology for which surgery was performed was adenoma (62). In (49) patients, there was no leakage (grade 0) during surgery, (19) patients had (grade 1), (10) had (grade 2), and only (5) cases had (grade 3).In all cases, we reconstructed the saddle according to the grade of defect, type )1( repair was the most common followed by type )2.( Also, postoperative cerebrospinal fluid leakage was observed in only )4( patients. It was concluded that our modified protocol for intraoperative CSF leaks grading and the repair techniques designed using sellar reconstruction after endoscopic resection of the pituitary tumors have proven to be an effective and reliable approach for postoperative CSF leak prevention and controlling.