title: Perforation of a nasoseptal flap does not increase the rate of postoperative cerebrospinal fluid leak.
abstract: BACKGROUND
  The nasoseptal flap (NSF) has been shown to be a valuable addition to the reconstructive armamentarium of the endoscopic skull-base surgeon. We aimed to evaluate the rate of postoperative cerebrospinal fluid (CSF) leak after use of a NSF that had a small tear during harvest.
  
  
  METHODS
  After Institutional Review Board (IRB) approval, we analyzed our database of patients undergoing skull-base resection. We included all patients who had a NSF reconstruction, septoplasty, and/or spur on preoperative computed tomography (CT) imaging. We then evaluated video of each procedure to determine if a tear occurred in the NSF during harvest. Patient records were reviewed to determine if a postoperative CSF leak occurred.
  
  
  RESULTS
  We evaluated video of 21 patients who underwent a skull-base resection, were reconstructed with a NSF, and had either a septoplasty or evidence of a septal spur on CT imaging. Of these 21 cases, 11 small tears occurred during harvest of the NSF flap and none of the patients with a torn NSF had a postoperative CSF leak.
  
  
  CONCLUSIONS
  Our series shows a 0% postoperative CSF leak rate in patients undergoing skull-base reconstruction with a NSF that was torn during harvest. Small tears in the NSF do not seem to affect postoperative CSF leak rates.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Philadelphia, PA.
authors.forename: Colin
authors.initials: C
authors.lastname: Huntley
authors.forename: Alfred Marc Calo
authors.initials: AM
authors.lastname: Iloreta
authors.forename: Gurston G
authors.initials: GG
authors.lastname: Nyquist
authors.forename: Marc
authors.initials: M
authors.lastname: Otten
authors.forename: Hermes
authors.initials: H
authors.lastname: Garcia
authors.forename: Christopher
authors.initials: C
authors.lastname: Farrell
authors.forename: Marc R
authors.initials: MR
authors.lastname: Rosen
authors.forename: James J
authors.initials: JJ
authors.lastname: Evans
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065634:Cerebrospinal Fluid Leak / Q000209:etiology*; D004724:Endoscopy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009300:Nasal Septum / Q000293:injuries* / Q000637:transplantation; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012421:Rupture; D019291:Skull Base / Q000601:surgery*; D013524:Surgical Flaps
keywords: CSF leak; NSF; nasoseptal flap; septoplasty; skull-base reconstruction