Optimizing sellar reconstruction after pituitary surgery with free mucosal graft: results in the first 50 consecutive patients

Abstract Background Postoperative CSF leak after endoscopic pituitary surgery ranges from 1.9-10% in different series. Vascularized flaps have reduced the incidence of leak, however it carries nasal morbidity. This paper presents a technique for sellar reconstruction with free mucosal graft from the nasal cavity floor including inferior meatus mucosa. This technique aims to standardize sellar reconstruction without the use of the nasoseptal flap and keeping the advantage of mucosal coverage of the defect in all cases. Methods Fifty patients who had endoscopic surgery for pituitary tumors and reconstruction with nasal cavity floor free mucosal graft were retrospectively reviewed. There were a total of 50 patients with postoperative follow-up from 3-16 months. Collagen dural graft was used inlay and free mucosal graft overlay to cover the sellar defect. No fat grafts or lumbar drains were used. Sinonasal outcome test-22 was obtained before and one month after surgery. Results There were 40% detected intraoperative leaks and no postoperative leaks. Nasal endoscopy performed at 1-month follow-up showed complete healing of the graft to the skull base and near total or complete mucosalization of the donor site. No significant difference was found in the SNOT-22 comparing the total preoperative scores and 1-month. Conclusions The nasal cavity floor free mucosal graft is an easy and safe technique with minimal nasal morbidity. There were no postoperative CSF leaks, despite aggressive tumor resection. No lumbar drains or fat graft were used. The harvest of mucosal graft does not worsen the quality of life measured with the SNOT test.