Nasoseptal Flap Takedown and Reuse in Endoscopic Skull Base Reconstruction

Introduction: As the boundaries of endoscopic skull base surgery become stretched, the boundaries of endoscopic skull base reconstruction must also widen. The pedicled nasoseptal flap has been a great advance in endoscopic skull base reconstruction. The primary objective is to learn the techniques and limitations of nasoseptal flap takedowns and reuse during second-stage and revision endoscopic skull base surgery.

Methods: Prospective consecutive analysis of CSF leak outcomes with nasoseptal flap takedown and reuse during endoscopic skull base surgery at a tertiary care skull base center.

Results: Sixteen consecutive cases of nasoseptal flap takedown and reuse for endoscopic endonasal intradural tumor surgery were collected prospectively and evaluated for CSF leak outcomes. Ten of these cases were planned second-stage surgeries and 6 were for revision and recurrent tumors. All 16 cases had intradural tumor extension and intraoperative CSF leaks at the time of the flap takedown and reuse. Fifteen of 16 had successful skull base reconstruction without postoperative CSF leak. One patient required revision endoscopic CSF leak repair and bolstering of the defect with a fat graft on postoperative Day 3. No flap deaths have occurred. Endoscopic skull base reconstructive techniques and limitations of flap takedowns are discussed.

Conclusions: The nasoseptal flap takedown and reuse for endonasal skull base reconstruction has excellent success (94%) and minimal additional nasal morbidity.