목적: Long-term outcomes of combining nasoseptal flap (NSF) and injectable hydroxyapatite (HXA) for rigid reconstruction in extended endoscopic endonasal transsphenoidal approaches (EETSA) without cerebrospinal fluid (CSF) diversion were evaluated. 방법:A retrospective cohort study was conducted on patients undergoing extended EETSA with NSF with HXA reconstruction without insertion of a lumbar drain for intraoperative high-flow grade 3 CSF leak between January 2016 and December 2023. The incidence of postoperative CSF leakage, meningitis, and complications associated with the use of injectable HXA, such as chronic granulation tissue formation and infection, were recorded. Demographics, diagnoses, defect locations, extent of resection, and reoperation rates were analyzed. 결과:One hundred patients received NSF with HXA reconstruction and were followed up for a mean duration of 20 months. Tuberculum sellae meningioma was most common pathology (39%), and the most common defect area was the transplanum/transtuberculum region (77%). The overall CSF leak rate was 0% after HXA repair. There were 8 cases of HXA exposure (8%), resulting in chronic granulation and local infection. All cases were prescribed a 2-week course of broad-spectrum antibiotics and managed conservatively. Three of the 8 patients (38%) showed complete re-mucosalization over the bared HXA area and the mean recovery time was 16 months (range, 5-26 months). There were no cases of meningitis or local infection requiring reoperation. 결론:In extended EETSA, combined NSF + HXA without CSF diversion as a reconstruction strategy for cases with an intraoperative high-flow grade 3 CSF leak shows long-term safety and efficacy. It is associated with good postoperative CSF leak outcomes and manageable complications.