Nasoseptal flap takedown and reuse in revision endoscopic skull base reconstruction.
OBJECTIVE
To provide a description of the techniques and limitations of nasoseptal flap takedown and reuse during second-stage and revision endoscopic skull base surgery and review the institutional experience with the use of this reconstructive technique.


METHODS
: Case series.


METHODS
A retrospective analysis of cerebrospinal fluid (CSF) leak outcomes was performed for a consecutive series of patients who underwent the nasoseptal flap takedown technique during endoscopic skull base surgery at two tertiary care skull base centers.


RESULTS
Twenty-eight consecutive cases with nasoseptal flap takedown procedures for endoscopic skull base reconstruction were collected and evaluated for flap viability and CSF leak outcomes. This cohort was composed of 14 revision surgeries and 14 planned second-stage procedures. There were no cases of flap loss. Twenty cases involved the presence of intraoperative CSF leaks. Twelve of these 20 cases were second-stage surgeries, and eight were revision or recurrent-tumor procedures. Nineteen of 20 had successful skull base reconstruction without a postoperative CSF leak. One patient required revision endoscopic CSF leak repair and bolstering of the defect with a fat graft 3 days after the initial surgery. Endoscopic skull base reconstructive techniques and limitations of flap takedowns are discussed.


CONCLUSIONS
Expansion of the limits of endoscopic skull base surgery must be accompanied by the development of new reconstructive options. This report illustrates the ability to take down and reuse the nasoseptal flap in staged and revision cases with a high success rate and minimal additional nasal morbidity.
Department of Otolaryngology-Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. adam_zanation@med.unc.edu
Adam M
AM
Zanation
Ricardo L
RL
Carrau
Carl H
CH
Snyderman
Kibwei A
KA
McKinney
Stephen A
SA
Wheless
Amol M
AM
Bhatki
Paul A
PA
Gardner
Daniel M
DM
Prevedello
Amin B
AB
Kassam
D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000601:surgery; D004724:Endoscopy; D006801:Humans; D007431:Intraoperative Complications; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D019291:Skull Base / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000601:surgery; D013524:Surgical Flaps