Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-20T03:51:56.686Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  09 May 2019

C Singh  and
N Shah
C Singh*
Affiliation:
Department of Otorhinolaryngology, Bombay Hospital and Institute of Medical Science, Mumbai, India
N Shah
Affiliation:
Department of Otorhinolaryngology, Bombay Hospital and Institute of Medical Science, Mumbai, India
*
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: cheer7us@yahoo.com Fax: +91 022 2208 0871
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

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

Methods

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.

Results

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.

Conclusion

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.

Keywords

Posterior Nasal Septal FlapSkull BaseCerebrospinal Fluid LeakSurgical Flaps
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 133 , Issue 5 , May 2019 , pp. 380 - 385
Copyright
Copyright © JLO (1984) Limited, 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

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

References

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;116:1882–6Google Scholar
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;117:1329–32Google Scholar
3Schick, B, Ibing, R, Brors, D, Draf, W. Long-term study of endonasal duraplasty and review of the literature. Ann Otol Rhinol Laryngol 2001;110:142–7Google Scholar
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;63:52–3Google Scholar
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;1315–43Google Scholar
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;58:246–56Google Scholar
7Hegazy, HM, Carrau, RL, Snyderman, CH, Kassam, A, Zweig, J. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea: a meta-analysis. Laryngoscope 2000;110:1166–72Google Scholar
8Schick, B, Draf, W. How I do it: endoscopic-microscopic anterior skull base reconstruction. Skull Base 2007;17:53–8Google Scholar
9Carrabba, G, Dehdashti, AR, Gentili, F. Surgery for clival lesions: open resection versus the expanded endoscopic endonasal approach. Neurosurg Focus 2008;25:E7Google Scholar
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;16:1–13Google Scholar
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;18:297–308Google Scholar
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;34:188–94Google Scholar
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;23:439–45Google Scholar
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;4:257–9Google Scholar
15Rotenberg, BW, Saunders, S, Duggal, N. Olfactory outcomes after endoscopic transsphenoidal pituitary surgery. Laryngoscope 2011;121:1611–13Google Scholar