1 / 25

Endoscopic Posteriorly Based Nasal Septal Flap in Skull Base and Nasal Septal Reconsruction

Purpose . Describe an endoscopic septal mucosal flap based on the sphenopalatine artery and its applicationRepair of skull base defects after endoscopic transnasal-trans-sphenoidal pituitary surgeryRepair of nasal septal perforations. Background. Pituitary SurgeryDecreased complication ratesDiabetes IsipidusVisual disturbanceCarotid artery injuryMeningitisCerebrospinal fluid fistulae.

adah
Télécharger la présentation

Endoscopic Posteriorly Based Nasal Septal Flap in Skull Base and Nasal Septal Reconsruction

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. Endoscopic Posteriorly Based Nasal Septal Flap in Skull Base and Nasal Septal Reconsruction Behrooz A. Torkian MD Vikas Mehta Timothy F. Kelley MD June 10, 2005

    2. Purpose Describe an endoscopic septal mucosal flap based on the sphenopalatine artery and its application Repair of skull base defects after endoscopic transnasal-trans-sphenoidal pituitary surgery Repair of nasal septal perforations

    3. Background Pituitary Surgery Decreased complication rates Diabetes Isipidus Visual disturbance Carotid artery injury Meningitis Cerebrospinal fluid fistulae

    4. Background Nasal and Anterior Skull Base Surgery Inverting Papilloma control rates improving Septoplasty techniques Invasive and expansive nasal/skull base lesions

    5. Goals Describe basic anatomy and blood supply of the nasal septal mucosa Describe the design and elevation of a posteriorly-based septal mucosal flap Describe the use of the septal flap in repair of septal perforation, and sphenoidotomy defect after trans-sphenoidal surgery Case review of the above

    6. Septal Blood Supply

    7. Sphenopalatine Artery Branch of the internal maxillary artery Passes through the sphenopalatine foramen Splits into the posterior lateral and posterior septal branches (anastomoses with posterior and anterior ethmoid)

    8. Septal Blood Supply

    9. Sphenopalatine Artery

    10. Pituitary Surgery Defect

    11. Flap Design

    12. Flap Design

    13. Septal Perforation

    14. Flap Design

    15. Flap Design - Septal Perforation

    17. Case Series Septal Perforations

    18. Septal perforation Female : Male – 5:1 Age average – 41 Average follow up 5.3 mo. Previous attempts 2/6 Causes Septal surgery 66% Cocaine 16% Other procedures 16% Success Complete healing 5/6 Microperforation 1/6 Flap viability 6/6 Complications Bleeding 1/6 Anosmia 0 Synechiae 0 Nasal obstruction 0 Crusting 0

    19. Case Series Pituitary Surgery

    20. Endoscopic pituitary All female Age Avereage – 42 Pathology Macroadenoma 4/5 Rathke’s cleft cyst 1/5 CSF leak intaoperative 2/5 Lumbar drain 2/5 Postoperative CSF 0 Hospital Days 5.3 Average follow up 9 mo Complications Bleeding 0 Anosmia 1/5 (unilateral flap) Synechiae 2/5 Crusting 1/5 Nasal obstruction 0

    21. Observations All flaps viable Even in smokers Septal perforations remained closed Coccaine users Rapidly healed well mucosalized sphenoid defects in pituitary surgery patients

    22. Complications Epistaxis more often with septal perforation Synechiae More common with pituitary Middle turbinate resection Anosmia Temporary in most One persists at 2 months, but only had unilateral flap elevation.

    23. Advantages Vascular pedicle Excellent mobility Reliable low-tension closure Can be useful in revision cases Mucosal coverage for pituitary defects Perforations can be preformed with a unilateral approach in some cases

    24. Disadvantages Learning curve Revision potentially difficult if bilateral Synechiae in cases requiring partial middle turbinectomy

    25. References Gandhi C, et al. Historic movements in transsphenoidal surgery. Neurosurg Focus 11 (4); 2001 Zhang Q, et al. Endoscope-assisted repair of large septal perforation using a complex mucoperichondrial flap and free tissue graft. Chinese Medical Journal 2003;116(1):157-158. Peter Casano, Virtual sinus anatomy 1996 Shiley S, et al. Incidence, etiology and management of CSF leak following trans-sphenoidal surgery. Laryngoscope 113:1283-88, 2003 Fairbanks DN. Closure of nasal septal perforations. Arch Otolaryngol Head Neck.Surg. 1980;106:509-513.

More Related