J Neurol Surg B Skull Base 2025; 86(S 01): S1-S576
DOI: 10.1055/s-0045-1803860
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Occurrence Flap Necrosis and Infection in the Reconstructive Protocol Using the Nasoseptal Flap After Endoscopic Skull Base Surgery: A Systematic Review and Meta-analysis

Authors

  • Filipe V. Ribeiro

    1   Barão de Mauá, Faculty of Medicine, Ribeirao Preto, Brazil

  • Lucca Palavani

    2   Max Planck University Center, Indaiatuba, São Paulo, Brazil

  • Marcelo P. Porto Sousa

    3   Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

  • Marcio Yuri Ferreira Ferreira

    4   Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, New York, United States

  • Filipi F. Andreão

    3   Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

  • Jéssica Oliveira

    5   National University of Rosario, Santa Fe, Argentina

  • Lucas Mitre

    6   Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil

  • Eduardo Corrêa

    7   Departamento de Neurocirurgia do Hospital Universitário Pedro Ernesto, Rio de Janeiro, Brazil

  • Rafaela Jucá

    8   State University of Campinas, São Paulo, Brazil

  • Eloisa Bittencurt Thomaz de Assis Assis

    9   Baltic Federal University, Kaliningrad, Russia

  • Luciano Coelho

    10   Hospital Universitário da Universidade Federal do Maranhão (HUUFMA), Sao Luis, Brazil

  • Allan Polverini

    11   Department of Neurosurgery, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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    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%).

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    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.


     

    No conflict of interest has been declared by the author(s).

    Publication History

    Article published online:
    07 February 2025

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