Nasoseptal Flap Elevation in Patients with History of Septal Surgery: Does It Increase Flap Failure or Cerebrospinal Fluid Leakage?
OBJECTIVE
The nasoseptal flap (NSF) has been shown to be a mainstay in the reconstruction of skull base defects. We evaluated the efficacy and complications of NSF in patients with a history of septal surgery who had the potential risk of tearing and poor vascularity.


METHODS
We performed a retrospective chart and video review of patients who underwent NSF for skull base reconstruction between February 2012 and May 2015. Comparison was made between 18 patients (revision group) who had a history of septoplasty and/or transseptal transsphenoidal approach and 88 patients (primary group) without a history of septal surgery. Laceration when raising the flap, vascularity on postoperative magnetic resonance imaging, viability on postoperative endoscopy, and cerebrospinal fluid (CSF) leakage were compared between the revision and primary groups.


RESULTS
Laceration of the flap occurred during NSF elevation in 2 patients (11.1%) in the revision group and 4 patients (4.5%) in the primary group (P = 0.269). Poor flap vascularity on magnetic resonance imaging was observed in 2 patients (11.1%) in the revision group and 8 patients (9.1%) in the primary group (P = 0.674). The rate of flap necrosis on endoscopy was 5.6% in the revision group and 1.1% in the primary group (P = 0.312). There was no significant difference in CSF leakage rate between the 2 groups (revision 5.6% and primary 10.2%).


CONCLUSIONS
There was no difference in rate of CSF leakage or flap integrity between the 2 groups. Therefore, NSF for skull base reconstruction is feasible in patients with a history of septal surgery.
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Woori
W
Park
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: kkam97@gmail.com.
Sang Duk
SD
Hong
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Do-Hyun
DH
Nam
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Doo-Sik
DS
Kong
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Gwanghui
G
Ryu
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Hyo Yeol
HY
Kim
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Seung-Kyu
SK
Chung
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Hun-Jong
HJ
Dhong
D065634:Cerebrospinal Fluid Leak / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D022125:Lacerations / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009300:Nasal Septum / Q000637:transplantation*; D057605:Natural Orifice Endoscopic Surgery / Q000706:statistics & numerical data*; D044583:Neuroendoscopy / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D019651:Plastic Surgery Procedures; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D019291:Skull Base / Q000601:surgery*; D013524:Surgical Flaps / Q000706:statistics & numerical data / Q000637:transplantation*; D017211:Treatment Failure; D016896:Treatment Outcome
Cerebrospinal fluid leakage; Nasoseptal flap; Septal surgery; Skull base reconstruction