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Unexpected prominent tension pneumosella five years after endoscopic endonasal transsphenoidal surgery
Author(s) -
Matsuda Tatsuma,
Horiguchi Kentaro,
Higuchi Yoshinori,
Hanazawa Toyoyuki,
Okamoto Yoshitaka,
Iwadate Yasuo
Publication year - 2018
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27060
Subject(s) - medicine , invagination , endoscopic endonasal surgery , transsphenoidal surgery , pituitary adenoma , surgery , skull , nasal septum , cavernous sinus , basilar invagination , endoscope , nose , adenoma , pathology , decompression
Tension pneumosella (TP) is a rare entity reported as the invagination of the sphenoid sinus mucosa into the skull base after endonasal transsphenoidal surgery. Few studies have reported on TP, and in these studies, invagination is confined to either the intrasellar or suprasellar area. We encountered a case of unexpected prominent TP toward the intracranial space 5 years after endoscopic endonasal transsphenoidal surgery (EETS) for a nonfunctioning pituitary adenoma. In addition, we present a hypothesis of the underlying mechanism by a pressure gradient change between the extracranial and intracranial space in TP formation. For repair, a pedicled nasal septal flap was fabricated from the remaining part of the septal mucosa, and a pedicled inferior turbinate flap was created. Moreover, the nasal septal cartilage was used as a rigid support for reconstruction, which was useful for preventing TP recurrence. This is the first report of an unexpected prominent TP after EETS. It is important for otorhinolaryngologists and neurosurgeons to be aware of the possibility of TP following EETS. Laryngoscope , 1798–1801, 2018