title: Inaccurate Assessments of Anterior Cranial Base Malignancy Following Nasoseptal Flap Reconstruction.
abstract: Objective The nasoseptal flap (NSF) provides vascularized tissue for repair of skull base defects of various etiologies. However, the NSF repair after skull base resection for anterior cranial base malignancies may demonstrate radiologic findings confusing for recurrent or residual disease on postoperative surveillance imaging. The objective of the current study was to review neuroradiologic misinterpretations of NSF reconstruction following anterior cranial base malignancies. Methods A multicenter review of patients reconstructed with the NSF after endoscopic resection of anterior cranial base malignancies from 2008 to 2013 was performed. Data were collected regarding etiology, surgical technique, locoregional control, and postoperative radiologic assessments. Only patients with at least one postoperative surveillance scan with inaccurate assessment of residual or recurrent malignancy were included in the study. Results Over 5 years, 13 patients were identified who had erroneous reporting of malignancy due to NSF reconstruction. On average, two neuroradiologists interpreted the NSF as persistent or recurrent malignancy over this time period (range: 1-7). The key findings suspicious for recurrence were enhancement and soft tissue thickening of the NSF. These findings were present in at least one postoperative scan in all patients. Conclusion Neuroradiologists and rhinologists performing surveillance on patients with a history of skull base malignancy with NSF reconstruction should maintain collaborative efforts to accurately interpret radiologic findings of the NSF during postoperative imaging.
authors.affiliation: Division of Otolaryngology, Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States.
authors.forename: Erika
authors.initials: E
authors.lastname: Walsh
authors.affiliation: Division of Otolaryngology, Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States.
authors.forename: Elisa
authors.initials: E
authors.lastname: Illing
authors.affiliation: Department of Neurosurgery, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States.
authors.forename: Kristen O
authors.initials: KO
authors.lastname: Riley
authors.affiliation: Department of Radiology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States.
authors.forename: Joel
authors.initials: J
authors.lastname: Cure
authors.affiliation: Department of Otolaryngology, University of New South Wales, Sydney, Australia.
authors.forename: Aviva
authors.initials: A
authors.lastname: Srubiski
authors.affiliation: Department of Otolaryngology, University of New South Wales, Sydney, Australia.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Harvey
authors.affiliation: Division of Otolaryngology, Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States.
authors.forename: Bradford A
authors.initials: BA
authors.lastname: Woodworth
keywords: cranial base; endonasal skull base resection; endoscopic resection; endoscopic skull base surgery; nasoseptal flap; skull base malignancy; skull base tumor