Authors: Xin Tian, Jinmin Hao, Qingjiu Zhang, Xiaowei Zhang and Ling Chen.

Journal: BMC Surgery. Published October 27, 2026.

Study design: Single-centre retrospective before–after cohort (162 patients).

DOI: 10.1186/s12893-026-04245-9.

Key findings

The authors compared conventional, nonvascularized sellar repair in 80 patients with reconstruction using an autologous bone fragment plus pedicled nasoseptal mucosal flap in 82 patients following transsphenoidal pituitary surgery.

• Postoperative CSF leak: 2/82 (2.44%) with combined reconstruction versus 11/80 (13.75%) in the conventional group (p = 0.009).
• Adjusted odds ratio for postoperative leak with combined reconstruction: 0.15 (95% CI 0.03–0.72), using a Firth penalized regression model.
• Mean operative times were 118.2 versus 113.5 minutes (p = 0.232), without a statistically significant difference.
• Intraoperative CSF leak was associated with increased postoperative leak risk (adjusted OR 5.12, 95% CI 1.46–17.96).

Why this matters for skull base surgery

The study addresses a major concern in endoscopic endonasal pituitary surgery: reducing postoperative CSF leaks through robust multilayer sellar reconstruction. However, the sequential cohort design, the small number of leak events, and the simultaneous introduction of bone and vascularized flap prevent causal conclusions or comparison against a flap-only technique.