Background and Aim: Pituitary adenomas commonly require endoscopic transsphenoidal surgery (ETSS). Although ETSS is minimally invasive, intraoperative cerebrospinal fluid (CSF) leaks occur in up to 50% of cases and can lead to meningitis or pneumocephalus if not well repaired. Autologous fat grafting from the periumbilical region is effective for dural reconstruction but carries donor-site morbidity and surgical-site infection (SSI). Buccal fat harvested intraorally reduces abdominal morbidity but risks contamination from oral flora. We evaluated a novel endonasal nasal-aperture approach to buccal fat harvest, hypothesizing comparable efficacy with fewer donor-site complications.
Methods and Materials/Patients: In a single-center, single-blinded, nonrandomized trial at Alzahra Hospital (affiliated with Isfahan University of Medical Sciences, Isfahan City, Iran, 2024–2025), 30 patients with macroadenomas undergoing ETSS were allocated 1:1 to nasal-aperture buccal fat harvest (n=15) or standard periumbilical abdominal fat harvest (n=15). The same surgeon used consistent anesthesia and postoperative protocols. The primary outcome was postoperative CSF leak. Secondary outcomes included operative time, length of stay, postoperative bleeding, SSI, donor-site pain, facial numbness, and cosmetic sequelae. Follow-up visits occurred at 2 weeks, 1, 2, 4 months, and 1 year. Statistical comparisons used the t-test, Mann-Whitney U test, and chi-square test (α=0.05).

Results: Groups were demographically similar (mean age 48.2±3 years; 56.7% male; mean BMI 25.4±1.2 kg/m²). Operative time (116.7±3.2 vs 115.9±3.8 min, P=0.54) and hospital stay (4.6±0.5 vs 4.5±0.5 days, P=0.67) did not differ between study groups. Both groups achieved 100% CSFleak closure without graft failure. The nasal-aperture group had significantly lower postoperative bleeding (20% vs 66.7%, P=0.01) and SSI (6.7% vs 33.3%, P=0.04). Transient facial numbness occurred in 6.7% of the nasal-aperture group; one immediate asymmetry resolved within 24 hours. No persistent donor-site complications or neurologic deficits were observed.

Conclusion: Endonasal nasal-aperture buccal fat harvest during ETSS provides equivalent CSFleak prevention to abdominal fat grafting while reducing bleeding, infection risk, and donor-site morbidity, and improving cosmetic outcomes. Larger randomized, multicenter trials with longer follow-up and patient-reported outcomes are warranted.