title: Janus flap: bilateral nasoseptal flaps for anterior skull base reconstruction.
abstract: OBJECTIVE
  Large dural defects after extended endoscopic endonasal skull base resections require meticulous reconstruction to prevent a cerebrospinal fluid leak postoperatively. The nasoseptal flap is a vascularized tissue graft developed to aid in the multilayer reconstruction of the skull base. The purpose of this study is to describe the first experiences with bilateral nasoseptal flaps for reconstruction of very large skull base defects.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  Large tertiary referral center (New York Presbyterian Hospital).
  
  
  METHODS
  Five patients underwent a multilayer reconstruction after an extended endoscopic transsphenoidal skull base surgery that included bilateral nasoseptal flaps. Pathologies consisted of two pituitary macroadenomas, one planum sphenoidale meningioma, one craniopharyngioma, and one cavernous sinus hemangioma.
  
  
  RESULTS
  All five patients underwent successful skull base reconstruction without a cerebrospinal fluid leak, complication at the reconstruction site, or anterior extension of the posterior septal perforation.
  
  
  CONCLUSIONS
  Bilateral nasoseptal flaps are a viable option for large dural defects of the anterior and ventral skull base when one nasoseptal flap may not completely seal the entire defect.
authors.affiliation: Department of Otorhinolaryngology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA. ggnyquist@hotmail.com
authors.forename: Gurston G
authors.initials: GG
authors.lastname: Nyquist
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Anand
authors.forename: Ameet
authors.initials: A
authors.lastname: Singh
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Schwartz
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D002426:Cavernous Sinus; D002558:Cerebrospinal Fluid Otorrhea / Q000517:prevention & control; D003397:Craniopharyngioma / Q000601:surgery; D004724:Endoscopy; D005260:Female; D006391:Hemangioma / Q000601:surgery; D006801:Humans; D008297:Male; D008579:Meningioma / Q000601:surgery; D008875:Middle Aged; D009296:Nasal Cavity; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D019291:Skull Base / Q000601:surgery*; D013524:Surgical Flaps; D020858:Tissue and Organ Harvesting