Endoscopic Skull Base Reconstruction with the Use of the Nasoseptal Flap: The TASMC Experience

Objective: The endoscopic endonasal approach is being increasingly used for the resection and reconstruction of anterior skull base lesions. Since its description in 2006, the vascularized nasoseptal flap (NSF) has become the workhorse for the reconstruction of the anterior skull defects with a significant decrease in the incidence of CSF leak. The objective of this study is to present our experience with the use of this flap and to report the complications associated with its use.

Study Design: Retrospective analysis of a tertiary care medical center.

Methods: The clinical records and surgical reports of all patients who underwent endoscopic skull base defect repair using a NSF at Tel-Aviv Sourasky Medical Center between January 2008 and August 2014 were retrospectively reviewed.

Results: Eighty patients underwent anterior skull base repair with the use of the nasoseptal flap. There were 48 men and 32 women. The mean age was 48 years (range, 2–83 years). 48% of patients underwent transsphenoidal surgery for pituitary lesions during which cerebral spinal fluid (CSF) leaks were observed. The remainder of patients had undergone reconstructive surgeries for posttraumatic CSF leaks or removal of lesions involving the anterior skull base. CD in the postoperative period and tumors involving the third ventricle all correlated with major complications (p = 0.034, 0.02, and 0.026 in accordance). More specifically intraoperative high flow CSF leak correlated with post-operative CSF leak (p = 0.01) and CD in the post-operative period correlated with meningitis (p = 0.04).

Conclusion: The nasoseptal flap is an extremely effective tool for skull base reconstruction. Utilization of continuous drainage, tumors involving the third ventricle and intra-operative high flow CSF leaks are significant risk factors for major complication.