Skip to main content Accessibility help

Posterior nasoseptal flap in the reconstruction of skull base defects following endonasal surgery

  • C Singh (a1) and N Shah (a1)



To study the clinical outcomes of a posterior nasoseptal flap used in the endonasal reconstruction of anterior skull base defects.


The early harvested flap was used to reconstruct anterior skull base defects in patients with high-flow on-table cerebrospinal fluid leak. Post-operatively, the patients were analysed for cerebrospinal fluid leak and bleeding.


Of the 100 patients, 87 had macro defects while 13 had micro defects. Non-secretary lesions were present in 60 patients, while secretary lesions were present in 40 patients. Cerebrospinal fluid leak was present in all the patients undergoing surgery, and the majority of them had a lumbar drain fitted. Post-operatively, two patients experienced bleeding and only two patients had a cerebrospinal fluid leak.


The use of a posterior nasoseptal flap for reconstruction of the anterior skull base amongst patients with a high-flow intra-operative cerebrospinal fluid leak can help prevent post-operative cerebrospinal fluid leak. Its applicability to wide patient profiles, with respect to age, size of defect and diagnosis, make it a versatile choice for reconstruction after endonasal anterior skull base surgical procedures.


Corresponding author

Author for correspondence: Dr Chandraveer Singh, Department of Otorhinolaryngology, Bombay Hospital and Institute of Medical Science, Marine Line, Mumbai, India, PIN code: 400020 E-mail: Fax: +91 022 2208 0871


Hide All

Dr C Singh takes responsibility for the integrity of the content of the paper



Hide All
1Hadad, G, Bassagasteguy, L, Carrau, RL, Mataza, JC, Kassam, A, Snyderman, CH et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006;116:1882–6
2Fortes, FS, Carrau, RL, Snyderman, CH, Prevedello, D, Vescan, A, Mintz, A et al. The posterior pedicle inferior turbinate flap: a new vascularized flap for skull base reconstruction. Laryngoscope 2007;117:1329–32
3Schick, B, Ibing, R, Brors, D, Draf, W. Long-term study of endonasal duraplasty and review of the literature. Ann Otol Rhinol Laryngol 2001;110:142–7
4Kassam, AB, Thomas, A, Carrau, RL, Snyderman, CH, Vescan, A, Prevedello, D et al. Endoscopic reconstruction of the skull base using a pedicled nasoseptal flap. Neurosurgery 2008;63:52–3
5Stammberger, H, Lund, VJ. Anatomy of the nose and paranasal sinuses. In: Gleeson, M, ed. Scott-Brown's Otorhinolaryngology, Head and Neck Surgery, 7th edn. Boca Raton, FL: CRC Press, 2008;1315–43
6Locatelli, D, Rampa, F, Acchiardi, I, Bignami, M, De Bernardi, F, Castelnuovo, P. Endoscopic endonasal approaches for repair of cerebrospinal fluid leaks: nine-year experience. Neurosurgery 2006;58:246–56
7Hegazy, HM, Carrau, RL, Snyderman, CH, Kassam, A, Zweig, J. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea: a meta-analysis. Laryngoscope 2000;110:1166–72
8Schick, B, Draf, W. How I do it: endoscopic-microscopic anterior skull base reconstruction. Skull Base 2007;17:53–8
9Carrabba, G, Dehdashti, AR, Gentili, F. Surgery for clival lesions: open resection versus the expanded endoscopic endonasal approach. Neurosurg Focus 2008;25:E7
10El-Banhawy, OA, El-Dien, Ael-H, Zolfakar, AS, Halaka, AN, Ayad, H. Endoscopic endonasal partial middle turbinectomy approach: adaptability of the procedure in a cadaveric study in surgery for different sphenoid sinus and skull base lesions. Skull Base 2006;16:113
11El-Banhawy, OA, Halaka, AN, Altuwaijri, MA, Ayad, H, El- Sharnoby, MM. Long-term outcome of endonasal endoscopic skull base reconstruction with nasal turbinate graft. Skull Base 2008;18:297308
12Eloy, JA, Patel, AA, Shula, PA, Choudhary, OJ, Liu, JK. Early harvesting of the vascularised pedicled nasoseptal flap during endoscopic skull base surgery. Am J Otolaryngol 2013;34:188–94
13Xuejian, W, Fan, H, Xiaobiao, Z, Yong, Y, Ye, G, Tao, X et al. Endonasal endoscopic skull base multilayer reconstruction surgery with nasal pedicled mucosal flap to manage high flow CSF leakage. Turk Neurosurg 2013;23:439–45
14Bernal-Sprekelsen, M, Rioja, E, Enseñat, J, Enriquez, K, Viscovich, L, Agredo-Lemos, FE et al. Management of anterior skull base defect depending on its size and location. Biomed Res Int 2014;4:257–9
15Rotenberg, BW, Saunders, S, Duggal, N. Olfactory outcomes after endoscopic transsphenoidal pituitary surgery. Laryngoscope 2011;121:1611–13
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed