Reconstruction with a novel pedicled mucoperiosteal hinge flap and dura suturing: a new minimally invasive concept and closure technique for endoscopic endonasal surgery

Objects The authors aimed to evaluate their experience with the minimally invasive reconstruction technique using pedicled mucoperiostea hinge flap (PMHF) with dura suturing after EES. Outcomes were compared with those of the traditional reconstruction using the NSF. Methods The authors conducted a retrospective cohort study involving 33 consecutive patients who underwent EES for pituitary adenoma resection. All these 33 patients were reconstructed with pedicled mucoperiosteal hinge flap with dura suturing and were compared with 32 consecutive patients treated previously using NSF technique. Surgical videos and electronic medical records were reviewed to assess operative times and postoperative outcomes, which were compared between the groups, with a particular focus on nasal function, assessed using the Endoscopic Endonasal Sinus and Skull Base Surgery Questionnaire (EES-Q). Results Demographics of the two groups were broadly similar. Among the 33 patients using PMHF with dura suturing, the average operative time decreased with experience, showing a trend of improved efficiency. No significant difference was observed between two groups in terms of total operative time. One postoperative CSF leak (3%) was observed in PMHF group, while 2 postoperative CSF leak (6%) occurred in group using NSF (P = 0.61). Importantly, patients who underwent reconstruction with pedicled mucoperiosteal hinge flap with dura suturing reported significantly lower EES-Q scores overall (p < 0.01), with better outcomes in all domains (p < 0.01). Conclusions This technique provides a reliable method for preventing postoperative CSF leak and a less invasive option, ultimately contributing to the preservation of the patient’s quality of life (QOL).