2025 Poster Presentations
P262: PATIENT REPORTED OUTCOMES ASSOCIATED WITH VIRTUAL SURGICAL PLANNING OF NASOSEPTAL FLAP RECONSTRUCTION OF SELLAR AND SUPRASELLAR LESIONS: PRELIMINARY ANALYSIS
Ryan A Rimmer, MD; S. Bulent Omay, MD; Yale School of Medicine
Introduction: Nasoseptal flaps (NSF) are the gold standard local method of reconstruction for cerebrospinal fluid leaks of the cranial base during endoscopic endonasal surgery. There is associated sinonasal morbidity with NSF harvest. Previous work has led to a technique of using 3D printing to estimate the smallest size NSF necessary based on the patient's anatomy and defect, in order to preserve maximum native mucosa and minimize morbidity. We present preliminary patient reported outcomes comparing virtual surgically planned (VSP) NSF versus standard NSFs in patients with sellar/suprasellar pathology.
Methods: All patients underwent endoscopic endonasal surgery at our institution with the same two surgeons. Only patients with sellar or suprasellar pathology and intraoperative CSF leaks were included. Patients were randomized to flap type. Inpatient or emergency cases in which 3D planning could not be performed received standard flap. Patients completed the Anterior Skull Base Nasal Inventory-12 (ASBNI) survey preoperatively and then again at postoperative follow up visits. Patients were seen at standard intervals postoperatively for nasal debridement.
Results: Ten patients underwent VSP NSF and eleven patients underwent standard NSF. Average age was 51.5 years in VSP group and 56.7 in standard group. There were more females in the VSP NSF group (N=9) vs the standard group (N=4). The average VSP NSF length (anterior-posterior) was 3.94 cm and height (cranio-caudal) was 2.05 cm. There were no postoperative cerebrospinal fluid leaks in either group.Two patients in the standard group did not complete preoperative ASBNI. Preoperative total ASBNI score was 4.75 for the VSP group and 5.5 for the standard group. The mean number of days between surgery date and first postoperative visit was 13.70 days for the VSP group and 17.9 for the standard group. Mean total ASBNI scores did not vary significantly between groups. At first postoperative visit, mean ASBNI score for the VSP group was 19.8 and 23.8 for the standard group (p 0.279). At the second postoperative visit, mean total ASBNI was 9.6 for the VSP group and 13.6 for the standard group (n=9) (p 0.4). At the third postoperative visit, mean total ASBNI was 4.25 for the VSP group and 5.34 for the standard group (N=6).
Conclusions: Our preliminary date is limited by the relatively small sample size, but VSP NSF appears to be well-tolerated with overall lower mean total ASBNI scores than patients receiving standard NSFs. This is particularly pronounced at the first and second postoperative visits before returning closer to preoperative scores by the third postoperative visit. Continued study with a larger sample size in needed for further analysis.