Approaches to Sellar Reconstruction

Multiple options are available for sellar reconstruction after endoscopic endonasal resection of pituitary masses. Neurosurgeons and otolaryngologists must be adept at assessing sellar defects and choosing appropriate repair techniques to minimize the risk of CSF leaks and complications. This activity addresses essential competencies, including evaluating the extent of CSF leaks, selecting optimal grafts, and applying multilayered reconstruction techniques for complex defects. Key takeaways include the importance of tailoring reconstruction to the severity of CSF leaks, the effectiveness of nasoseptal flaps for high-grade leaks, and the potential for minimalistic reconstructions in cases without intraoperative leaks. Understanding the historical evolution and current best practices in sellar repair enhances patient outcomes and reduces postoperative morbidity.