title: Early harvesting of the vascularized pedicled nasoseptal flap during endoscopic skull base surgery.
abstract: OBJECTIVE
  The vascularized pedicled nasoseptal flap (PNSF) represents a successful option for reconstruction of large skull base defects after expanded endoscopic endonasal approaches (EEA). This vascularized flap can be harvested early or late in the operation depending on the anticipation of high-flow CSF leaks. Each harvesting technique (early vs. late) is associated with different advantages and disadvantages. In this study, we evaluate our experience with early harvesting of the PNSF for repair of large skull base defects after EEA.
  
  
  METHODS
  A retrospective review was performed at a tertiary care medical center on patients who underwent early PNSF harvesting during reconstruction of intraoperative high-flow CSF leaks after EEA between December 2008 and March 2012. Demographic data, repair materials, surgical approach, and incidence of PNSF usage were collected.
  
  
  RESULTS
  Eighty-seven patients meeting the inclusion criteria were identified. In 86 procedures (98.9%), the PNSF harvested at the beginning of the operation was used. In 1 case (1.1%), the PNSF was not used because a high-flow intraoperative CSF leak was not encountered. This patient had recurrence of intradural disease 8months later, and the previously elevated PNSF was subsequent used after tumor resection.
  
  
  CONCLUSIONS
  Based on our data, a high-flow CSF leak and need for a PNSF can be accurately anticipated in patients undergoing EEA for skull base lesions. Because of the advantages of early harvesting of the PNSF and the high preoperative predictive value of CSF leak anticipations, this technique represents a feasible harvesting practice for EEA surgeries.
authors: Department of Otolaryngology - Head & Neck Surgery, University of Medicine and Dentistry of New Jersey - New Jersey Medical School, Newark, NJ, USA. jean.anderson.eloy@gmail.com.
authors: Jean Anderson
authors: JA
authors: Eloy
authors: Amit A
authors: AA
authors: Patel
authors: Pratik A
authors: PA
authors: Shukla
authors: Osamah J
authors: OJ
authors: Choudhry
authors: James K
authors: JK
authors: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000601:surgery*; D002648:Child; D004724:Endoscopy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014057:Tomography, X-Ray Computed; D055815:Young Adult