title: Risk Factors Predicting Nasoseptal Flap Failure in the Endoscopic Endonasal Transsphenoidal Approach.
abstract: OBJECTIVE
  Reconstruction of the skull base using a pedicled nasoseptal flap (NSF) seems to be advantageous after the endoscopic endonasal transsphenoidal approach (EETSA). A few reports have evaluated the cause of flap failure in EETSA using NSFs. The aim of this study was to evaluate the perioperative risk factors for NSF failure.
  
  
  METHODS
  Patient series.
  
  
  METHODS
  Retrospective review of medical records at a tertiary referral center.
  
  
  METHODS
  The study population comprised patients who underwent EETSA with NSF elevation between February 2009 and March 2014. The authors retrospectively reviewed the all patients' medical records, including operative findings.
  
  
  RESULTS
  Four hundred thirteen patients (203 males and 210 females) underwent EETSA, and 315 patients underwent EETSA with NSF elevation. The mean patient age was 48.0 years. The total number of patients of NSF failure was 6 (overall rate: 1.61%, 6/315; flap elevation: 0.31%, 1/315; flap reconstruction: 15.1%, 5/33). Two patients had diabetes mellitus. One patient had cardiovascular problems. Five patients were elderly (>60 years; mean age: 70 years). Five patients had postoperative nasal infection. One patient underwent preoperative radiation therapy.
  
  
  CONCLUSIONS
  Nasoseptal flap is a usually safe and effective technique for skull base reconstruction. However, the management of patients with diabetes mellitus, cardiovascular problems, advanced age, postoperative nasal infection, and radiation therapy may require more attention to improve NSF survival.
authors.affiliation: *Department of Otolaryngology-Head and Neck Surgery, Uijeongbu St. Mary's Hospital †Minimal Access and Robotic Surgery Center, Seoul St. Mary's Hospital ‡Department of Biomedical Science §Department of Neurosurgery, The Catholic University of Korea, College of Medicine, Seoul, Korea.
authors.forename: Boo-Young
authors.initials: BY
authors.lastname: Kim
authors.forename: Ji Hyeon
authors.initials: JH
authors.lastname: Shin
authors.forename: Sung Won
authors.initials: SW
authors.lastname: Kim
authors.forename: Yong Kil
authors.initials: YK
authors.lastname: Hong
authors.forename: Sin-Soo
authors.initials: SS
authors.lastname: Jeun
authors.forename: Soo Whan
authors.initials: SW
authors.lastname: Kim
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Cho
authors.forename: Yong Jin
authors.initials: YJ
authors.lastname: Park
mesh_terms: D000368:Aged; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D019291:Skull Base / Q000601:surgery*; D013524:Surgical Flaps / Q000473:pathology; D017211:Treatment Failure