title: Mucocele rate after endoscopic skull base reconstruction using vascularized pedicled flaps.
abstract: BACKGROUND
  Postoperative cerebrospinal fluid leak is a significant risk after endoscopic skull base surgery. Recently, novel reconstructive techniques using vascularized pedicled mucosal flaps have been applied to decrease this potential risk. Complete mucosal extirpation in the wound bed is not always feasible and the impact of insetting the flap over intact underlying mucosa is not clear. The purpose of this study was to determine the rate of mucocele formation after nasoseptal flap reconstruction without mucosal stripping.
  
  
  METHODS
  This is an Institutional Review Board-approved, retrospective study consisting of 28 patients undergoing skull base reconstruction using a pedicled nasoseptal flap between 2008 and 2010 at a tertiary care hospital. In all cases the sinus or skull base mucosa surrounding the defect was left intact. Patients were followed postoperatively by endoscopy and/or imaging for evidence of mucocele formation in the reconstructive bed.
  
  
  RESULTS
  The total rate of mucocele formation was 3.6% (1 of 28, noted on postoperative day 46). The mean follow-up time was 243 ± 174 days (range, 46-585 days). Eleven patients were followed for over 1 year. All flaps remained viable and well vascularized.
  
  
  CONCLUSIONS
  The pedicled nasoseptal flap is an effective means of reconstruction after endoscopic skull base surgery. Avoidance of extensive stripping of the surrounding mucosa does not result in a significant rate of postoperative mucocele formation in the short term. Long-term follow-up is still indicated.
authors.affiliation: Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA. bleierb@gmail.com
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Bleier
authors.forename: Eric W
authors.initials: EW
authors.lastname: Wang
authors.forename: W Alex
authors.initials: WA
authors.lastname: Vandergrift
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Schlosser
mesh_terms: D000328:Adult; D000368:Aged; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000517:prevention & control*; D003952:Diagnostic Imaging; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009078:Mucocele / Q000453:epidemiology* / Q000473:pathology; D009092:Mucous Membrane / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D019291:Skull Base / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000453:epidemiology* / Q000473:pathology; D013524:Surgical Flaps / Q000098:blood supply / Q000473:pathology / Q000706:statistics & numerical data*