Nasoseptal Flap Harvest after Previous Transnasal Transseptal Surgery

Objective: To evaluate the feasibility of using the nasoseptal flap in skull base reconstruction after previous transnasal transseptal surgery.

Methods: A retrospective review of cases undergoing endoscopic transnasal surgery from 12/7/2006 through 11/15/2009 was performed. Demographic information, the presenting tumor type, surgical approaches performed previously, the harvest of a nasoseptal flap, and the results of endoscopic surveillance at follow-up were recorded.

Results: A total number of 92 endoscopic procedures were performed in 77 patients. Tumor types seen included pituitary adenoma, craniopharyngioma, chordoma, meningioma, dermoid, and Rathke's cleft cyst. In all, 39 nasoseptal flaps were harvested.

Of the cases reviewed, 14 underwent endoscopic surgery for recurrent or persistent disease. Of these cases, 10 had had prior transnasal transseptal surgery. Among this subset of cases, 8 had a nasoseptal flap harvested during the most recent endoscopic surgeries. All of the flaps in this group were successfully harvested in anticipation of their use for skull base reconstruction. Three of these harvested flaps were not used for reconstruction and were placed back in their natural anatomic position to heal. Follow-up endoscopic surveillance confirmed that all of the nasoseptal flaps performed during endoscopic procedures in cases of prior transseptal surgery have survived.

Conclusion: The use of the nasoseptal flap for reconstruction of the anterior skull base is a reasonable option in those patients who have undergone previous transseptal surgery.