Direct Endonasal Approach with Partial Upper Posterior Septectomy. A “Rescue Flap” Technique Modification

Abstract

Objective?Report a modification of the ?rescue flap? technique using a direct endonasal approach with a partial superior septectomy for approaching pituitary tumors developed in our institution. Design?Prospective study. Setting?Hospital Universitario ?Dr. Jos? Eleuterio Gonz?lez,? Universidad Aut?noma de Nuevo Le?n. Main Outcome Measures?Since April 2015, we have performed 19 cases employing a direct endonasal approach with partial superior septectomy. Results and a technical note are described below. Results?Nineteen patients were included in this report. Six patients presented transoperatory cerebrospinal fluid (CSF) leak, so a nasoseptal rescue flap was harvested. No patients developed postoperative CSF leak in this group. Two patients were submitted to a second surgical procedure. Nasoseptal flap was harvested without complications. In both patients, the size of the flap was enough to cover the dural defect and avoid CSF leak. Conclusion?Direct endonasal approach with a partial posterior septectomy allows enough exposition of the sphenoidal sinus while preserving the nasoseptal septum with the possibility of a successful rescue flap when needed.

Endoscopic repair of lateral sphenoid Encephaloceles: a case series

“…Figure 2 shows the right lateral sphenoid encephalocele in patient #5 after wide sphenoidotomy and bipolar cauterization of the lateral sphenoid encephlocele. During exposure of the lateral sphenoid encephalocele the rescue flap modification of the nasoseptal flap was used to preserve the nasoseptal flap pedicle when an ipsilateral nasoseptal flap was utilized [ 3 – 5 ]. The nasoseptal flap was otherwise elevated and inlaid in the standard fashion [ 6 ].…”