Validity of the flap risk score in predicting nasoseptal flap use after endoscopic transsphenoidal pituitary mass resection
Introduction: There remains a paucity of literature examining the decision algorithm for use of nasoseptal flap (NSF) after endoscopic endonasal approaches (EEA) to pituitary adenoma resection. In 2018, we published the first ever flap risk score (FRS) to predict the use of NSF. We present here a va...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-04-01
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| Series: | World Neurosurgery: X |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590139724000619 |
| _version_ | 1797281212298952704 |
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| author | Arsalaan Salehani Matthew Parr Travis J. Atchley Sasha Howell Dagoberto Estevez-Ordonez Nicholas M.B. Laskay Kristen Riley |
| author_facet | Arsalaan Salehani Matthew Parr Travis J. Atchley Sasha Howell Dagoberto Estevez-Ordonez Nicholas M.B. Laskay Kristen Riley |
| author_sort | Arsalaan Salehani |
| collection | DOAJ |
| description | Introduction: There remains a paucity of literature examining the decision algorithm for use of nasoseptal flap (NSF) after endoscopic endonasal approaches (EEA) to pituitary adenoma resection. In 2018, we published the first ever flap risk score (FRS) to predict the use of NSF. We present here a validity study examining the FRS as applied to our center. Methods: A retrospective review was completed of consecutive patients undergoing EEA from January 2015 to March 2021. The sensitivity, specificity, and predictive value of the FRS were calculated. A multivariate logistic model was used to determine the relative weight imaging characteristics in predicting need for NSF. The relative weighting of the FRS was then re-optimized. Results: A total of 376 patients underwent EEA for pituitary adenoma resection, with 113 (30.1%) requiring NSF. The FRS had a sensitivity and specificity of 43.4% and 94.7%, respectively. Sphenoid sinus extension increased the odds of needing a NSF equivalent to 19 mm of tumor height, as opposed to 6 mm in the original 2018 cohort. The re-optimized model had sensitivity and specificity of 79.6% and 76.4%, respectively. Conclusion: We present a validity study examining the utility of FRS in predicting the use of NSF after EEA for pituitary adenoma resection. Our results show that while FRS is still predictive of the need for NSF after EEA, it is not as predictive now as it was for its original cohort. Therefore, a more comprehensive model is necessary to more accurately stratify patients’ preoperative risk for NSF. |
| first_indexed | 2024-03-07T16:53:21Z |
| format | Article |
| id | doaj.art-baccd77ea8d348139cb1f0436a6d632b |
| institution | Directory Open Access Journal |
| issn | 2590-1397 |
| language | English |
| last_indexed | 2024-03-07T16:53:21Z |
| publishDate | 2024-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | World Neurosurgery: X |
| spelling | doaj.art-baccd77ea8d348139cb1f0436a6d632b2024-03-03T04:30:08ZengElsevierWorld Neurosurgery: X2590-13972024-04-0122100330Validity of the flap risk score in predicting nasoseptal flap use after endoscopic transsphenoidal pituitary mass resectionArsalaan Salehani0Matthew Parr1Travis J. Atchley2Sasha Howell3Dagoberto Estevez-Ordonez4Nicholas M.B. Laskay5Kristen Riley6Dept. of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL, USADept. of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL, USADept. of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL, USA; Corresponding author. Department of Neurosurgery University of Alabama at Birmingham 1060 Faculty Office Tower 1720 2nd Avenue South Birmingham, AL 35294, USA.Dept. of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL, USADept. of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL, USADept. of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL, USADept. of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL, USAIntroduction: There remains a paucity of literature examining the decision algorithm for use of nasoseptal flap (NSF) after endoscopic endonasal approaches (EEA) to pituitary adenoma resection. In 2018, we published the first ever flap risk score (FRS) to predict the use of NSF. We present here a validity study examining the FRS as applied to our center. Methods: A retrospective review was completed of consecutive patients undergoing EEA from January 2015 to March 2021. The sensitivity, specificity, and predictive value of the FRS were calculated. A multivariate logistic model was used to determine the relative weight imaging characteristics in predicting need for NSF. The relative weighting of the FRS was then re-optimized. Results: A total of 376 patients underwent EEA for pituitary adenoma resection, with 113 (30.1%) requiring NSF. The FRS had a sensitivity and specificity of 43.4% and 94.7%, respectively. Sphenoid sinus extension increased the odds of needing a NSF equivalent to 19 mm of tumor height, as opposed to 6 mm in the original 2018 cohort. The re-optimized model had sensitivity and specificity of 79.6% and 76.4%, respectively. Conclusion: We present a validity study examining the utility of FRS in predicting the use of NSF after EEA for pituitary adenoma resection. Our results show that while FRS is still predictive of the need for NSF after EEA, it is not as predictive now as it was for its original cohort. Therefore, a more comprehensive model is necessary to more accurately stratify patients’ preoperative risk for NSF.http://www.sciencedirect.com/science/article/pii/S2590139724000619Endoscopic endonasal surgeryTranssphenoidal surgeryPituitary adenomaNasoseptal flapValidity |
| spellingShingle | Arsalaan Salehani Matthew Parr Travis J. Atchley Sasha Howell Dagoberto Estevez-Ordonez Nicholas M.B. Laskay Kristen Riley Validity of the flap risk score in predicting nasoseptal flap use after endoscopic transsphenoidal pituitary mass resection World Neurosurgery: X Endoscopic endonasal surgery Transsphenoidal surgery Pituitary adenoma Nasoseptal flap Validity |
| title | Validity of the flap risk score in predicting nasoseptal flap use after endoscopic transsphenoidal pituitary mass resection |
| title_full | Validity of the flap risk score in predicting nasoseptal flap use after endoscopic transsphenoidal pituitary mass resection |
| title_fullStr | Validity of the flap risk score in predicting nasoseptal flap use after endoscopic transsphenoidal pituitary mass resection |
| title_full_unstemmed | Validity of the flap risk score in predicting nasoseptal flap use after endoscopic transsphenoidal pituitary mass resection |
| title_short | Validity of the flap risk score in predicting nasoseptal flap use after endoscopic transsphenoidal pituitary mass resection |
| title_sort | validity of the flap risk score in predicting nasoseptal flap use after endoscopic transsphenoidal pituitary mass resection |
| topic | Endoscopic endonasal surgery Transsphenoidal surgery Pituitary adenoma Nasoseptal flap Validity |
| url | http://www.sciencedirect.com/science/article/pii/S2590139724000619 |
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