J Neurol Surg B Skull Base 2020; 81(S 01): S1-S272
DOI: 10.1055/s-0040-1702466
Oral Presentations
Georg Thieme Verlag KG Stuttgart · New York

The Rhinopharyngeal (RP) Flap as an Adjunct to Endoscopic Endonasal Reconstruction of Lower Clival and Craniovertebral Junction Defects

Pierre-Olivier Champagne
1   University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United Stated
,
Georgios Zenonos
1   University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United Stated
,
Eric E. Wang
1   University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United Stated
,
Carl H. Snyderman
1   University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United Stated
,
Paul A. Gardner
1   University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United Stated
› Author Affiliations
Further Information

Publication History

Publication Date:
05 February 2020 (online)

 

Context: Endoscopic endonasal approach (EEA) to the lower clivus and craniovertebral junction (CVJ) has been traditionally performed via resection of the nasopharyngeal soft tissues. Alternatively, an inferiorly based rhinopharyngeal (RP) flap can be dissected to help cover the postoperative defect and separate it from the oropharynx. To date, there is no evidence on the viability and potential clinical impact of the RP flap.

Methods: A retrospective cohort of 60 patients who underwent EEA to the lower clivus and craniovertebral junction was studied. The RP flap was used in 30 patients (RP group) and the nasopharyngeal soft tissues were resected in 30 patients (control group).

Results: Chordoma was the most common surgical indication in both groups (47 vs. 63% in RP and control group, respectively, p = 0.313), followed by odontoid pannus (20 vs. 10% in RPF and control group, respectively, p = 0.313). No complications occurred during the RP flap harvesting. The two groups did not differ in terms of extent and size of tumor (p = 0.271), intraoperative CSF leak (p = 0.438), and skull base reconstruction techniques other than RP flap (nasoseptal flap: p = 0.301, fascia lata: p = 0.791, inlay graft: p = 0.793, and prophylactic lumbar drain: p = 0.781). Postoperative soft-tissue enhancement (MRI) covering the lower clivus and CVJ was significantly higher in the RPF group (70 vs. 23%, p < 0.001). The control group had a significantly higher rate of nasoseptal flap necrosis (20 vs. 3%, p = 0.044) and surgical site infection (27 vs. 3%, p = 0.026) while having similar rates of postoperative CSF leak (17 vs. 20% in RP and control groups, respectively, p = 0.739) and meningitis (7 vs. 17% in RP and control groups, respectively, p = 0.424).

Conclusion: The RP flap provides vascularized tissue coverage in anterior and inferior to the lower clivus and CVJ. Its use was associated with decreased rates of nasoseptal flap necrosis and local infection.