Occurrence Flap Necrosis and Infection in the Reconstructive Protocol Using the Nasoseptal Flap After Endoscopic Skull Base Surgery: A Systematic Review and Meta-analysis

Introduction The: Endoscopic endonasal approach has been successfully used for the management of pituitary tumors. However, the loss of septal mucosa especially around the sphenoethmoidal recess and posterior nasal septum might be a disadvantage of this technique. Thus, due to the scarce literature on the subject, the results of flap necrosis and Infection need to be elucidated.

Objective: The objective of the present study is to evaluate the occurrence flap necrosis and hyposmia in the reconstructive protocol using the nasoseptal flap after endoscopic skull base surgery.

Methods: We searched Medline, Embase, and Web of Science databases following PRISMA guidelines. We used single proportion analysis with 95% confidence intervals under a random-effects model, I2 to assess heterogeneity, and Baujat and sensitivity analysis to address high heterogeneity. Eligible studies included those with ≥3 patients treated with nasoseptal flap after endoscopic skull base surgery.

Results: Of the 484 initial studies found in the literature, 23 studies with 705 patients were selected. The main complications resulting from transnasal endoscopic surgery for the treatment of skull-base tumors were evaluated. Among the analyzed studies, four presented flap necrosis data, and the analysis revealed a remarkable rate of 1% (95% CI: 0–2%). In addition, when assessing the occurrence of infection, three studies reported data on the occurrence or not of this complication, the analysis showed a rate of 1% (95% CI: 0–3%).

Conclusion: Based on the results, our meta-analysis identified that the use of the nasoseptal flap in patients undergoing endoscopic surgery for cranial-based tumors has been shown to be safe and effective, based on the low incidence of Flap necrosis and Infection.

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Artikel online veröffentlicht:
07. Februar 2025