Estimating nasoseptal flap length for sellar reconstruction: a surgical and radiological study

Objective: To assess whether computed tomography (CT) can predict the nasoseptal flap length necessary for reconstruction after endoscopic approaches to the sellar region. Methods: Twenty consecutive patients who underwent endoscopic resection of pituitary adenoma were included, and data were obtained prospectively in 2 stages, one radiological and one surgical. The length of the flap as estimated by CT (CT-Est) was compared with the flap length considered optimal (Ideal Flap), after intraoperative measurements. Correlation between the 2 values was assessed with the Spearman correlation test. Results: The mean length estimated on CT scans was 63.8 ± 2.3 mm, and the mean Ideal Flap was 59.1 ± 2.3 mm. The mean difference (Δ CT-Est - Ideal Flap) between these 2 values was 4.7 ± 0.7 mm. The Spearman coefficient of correlation between Ideal Flap and CT-Est was 0.938 (95% CI = 0.843 to 0.976), with p = 0.001, denoting a very strong and statistically significant correlation. Conclusions: CT-based estimates closely approximated the nasoseptal flap length required for reconstruction of a sellar approach defect. CT has the potential to be a useful tool for preoperative planning of tailored flaps.