J Neurol Surg B Skull Base 2016; 77 - FP-19-01
DOI: 10.1055/s-0036-1592533

Complications of Nasoseptal Flap Reconstruction

Carl H. Snyderman 1, 2, Joseph D. Chabot 2, Nicholas R. Rowan 1, Eric W. Wang 1, Paul A. Gardner 2, Juan C. Fernandez-Miranda 2
  • 1Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

Objective: The vascularized nasoseptal flap (NSF) has been widely adopted for the reconstruction of ventral skull base defects. Little is known about the potential complications and morbidity of the NSF. We reviewed our institution's experience with the NSF to describe complications and nasal morbidity associated with the use of this flap.

Methods: A retrospective review of endoscopic endonasal surgeries (EES) was performed to identify the incidence and risk factors for NSF necrosis and postoperative nasal deformities in two separate groups of patients.

Results: Of 601 patients undergoing EES with NSF reconstruction, 6.7% had confirmed postoperative cerebrospinal fluid (CSF) leaks and well-vascularized flaps. 1.2% of patients had NSF necrosis; only 3 of 8 patients had a CSF leak. Necrotic NSF were less likely to enhance on postoperative magnetic resonance imaging (p < 0.001) and these patients were more likely to develop meningitis (p = 0.001). Risk factors for necrotic NSF included prior EES. 5.8% of 328 patients undergoing EES developed nasal dorsum collapse in the postoperative period. Nasal deformities were only observed in patients with NSF reconstruction (p = 0.0001) and were associated with more extensive surgeries (p = 0.002).

Conclusion: The NSF is a reliable and effective method of reconstruction during EES of the skull base. The risk of NSF necrosis is low. Patients who develop meningitis with a non-enhancing flap on MRI should be evaluated for NSF necrosis. Nasal dorsum collapse following EES is associated with NSF reconstruction. The mechanism is not known.