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Posterior pedicle inferior turbinate flap for recurrent cerebrospinal fluid leak following endoscopic transsphenoidal surgery

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Abstract

Background

Adequate reconstruction of skull base following endoscopic transsphenoidal surgery is the most crucial step in reducing postoperative morbidity and mortality. Although, the success rate of traditional nasoseptal flap is very high, specific surgical scenarios preclude its use. A variety of vascularised endonasal and tunnelled scalp flaps have been described in the literature to address such situations. Posterior pedicle inferior turbinate flap (PPITF) is one such locally available vascularised flap.

Methods

Two patients with recurrent CSF leak following endoscopic transsphenoidal resection of pituitary adenoma were included. The nasoseptal flap was not available in both patients due to previous surgery. Hence, a PPITF based on the posterolateral nasal artery, a branch of sphenopalatine artery, was harvested and used for skull base reconstruction.

Results

In both patients, CSF leak subsided in the immediate postoperative period. In one patient, sensorium improved and was subsequently discharged in stable condition. Other patient succumbed to meningitis in the postoperative period.

Conclusions

The PPITF is a valuable alternative to the conventional nasoseptal flap when the latter is not available and it is very important for an endoscopic skull base surgeon to be familiar with the technique of harvesting and using the PPITF.

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Fig. 1
Fig. 2

Abbreviations

CSF:

Cerebrospinal fluid

EEA:

Endoscopic endonasal approaches

PPITF:

Posterior pedicle inferior turbinate flap

IT:

Inferior turbinate

EVD:

External ventricular drain

CEMRI:

Contrast enhanced magnetic resonance imaging

H–B:

Hadad–Bassagasteguy

SPA:

Sphenopalatine artery

PLNA:

Posterior lateral nasal artery

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Authors and Affiliations

  1. Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India

    Sundarakrishnan Dharanipathy, Amandeep Kumar & Deepak Agrawal

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  1. Sundarakrishnan Dharanipathy
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  2. Amandeep Kumar
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  3. Deepak Agrawal
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Correspondence to Amandeep Kumar.

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Dharanipathy, S., Kumar, A. & Agrawal, D. Posterior pedicle inferior turbinate flap for recurrent cerebrospinal fluid leak following endoscopic transsphenoidal surgery. Eur Arch Otorhinolaryngol 280, 4279–4283 (2023). https://doi.org/10.1007/s00405-023-08096-5

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