Bone fragment plus nasoseptal flap linked to fewer CSF leaks after pituitary surgery

Surgeons at a single centre report that a sellar floor reconstruction technique combining an autologous bone fragment with a pedicled nasoseptal mucosal flap was associated with markedly fewer postoperative cerebrospinal fluid leaks than their previous repair protocol in patients undergoing transsphenoidal pituitary adenoma surgery. The findings appear in BMC Surgery as a retrospective, single-centre before–after cohort study.

Postoperative cerebrospinal fluid leak occurred in 2 of 82 patients, or 2.44 percent, in the combined group, compared with 11 of 80 patients, or 13.75 percent, in the conventional group, a difference the authors report as statistically significant with a P value of 0.009.

In that model, combined reconstruction remained associated with lower odds of postoperative cerebrospinal fluid leak than conventional repair, with an adjusted odds ratio of 0.15 and a 95 percent confidence interval of 0.03 to 0.72, and a P value of 0.018.

The same model identified intraoperative cerebrospinal fluid leak as a risk factor for postoperative leak. Compared with patients who had no intraoperative leak, those who did had higher odds of a postoperative leak, with an adjusted odds ratio of 5.12, a 95 percent confidence interval of 1.46 to 17.96, and a P value of 0.011.

Operative time was similar between the groups. Mean operative time was 118.2 plus or minus 24.7 minutes in the combined group versus 113.5 plus or minus 25.1 minutes in the conventional group, a non-significant difference with a P value of 0.232, indicating that the combined technique did not add a statistically significant amount of surgical time.

Nasal complications occurred in 2.44 percent of patients in the combined group versus 7.50 percent in the conventional group, a difference that was not statistically significant with a P value of 0.165. At 24 months, 92.68 percent of patients in the combined group versus 83.75 percent in the conventional group were classified as cured, which was also not statistically significant with a P value of 0.091.

The authors caution that the study’s sequential before–after design, the limited number of leak events, and the fact that the bone fragment and the flap were introduced simultaneously preclude causal attribution. They also note that the design does not allow conclusions about whether the combined technique is superior to flap-only reconstruction, since no flap-only comparison arm was included.

Within those limitations, the retrospective experience suggests that adding an autologous bone fragment to a pedicled nasoseptal flap for sellar floor reconstruction may reduce postoperative cerebrospinal fluid leaks after transsphenoidal pituitary surgery without significantly prolonging operative time, and that intraoperative leak status should be considered when assessing postoperative leak risk.

Subject of Research: Sellar floor reconstruction techniques after transsphenoidal pituitary adenoma surgery

Article Title: Combined autologous bone fragment and pedicled nasoseptal mucosal flap for sellar floor reconstruction after transsphenoidal pituitary surgery: a single-centre retrospective experience

Article References: Tian, X., Hao, J., Zhang, Q., Zhang, X., & Chen, L. (2026). Combined autologous bone fragment and pedicled nasoseptal mucosal flap for sellar floor reconstruction after transsphenoidal pituitary surgery: a single-centre retrospective experience. BMC Surgery. https://doi.org/10.1186/s12893-026-04245-9

Image Credits: AI Generated

DOI: 10.1186/s12893-026-04245-9

Keywords: transsphenoidal surgery, pituitary adenoma, cerebrospinal fluid leak, sellar floor reconstruction, nasoseptal flap, autologous bone fragment, retrospective cohort, Firth logistic regression, skull base surgery, BMC Surgery, Combined, autologous