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Endoscopic pedicled nasoseptal flap reconstruction for pediatric skull base defects

Authors

  • Rupali N. Shah MD,

    1. Department of Otolaryngology–Head and Neck Surgery, University of North Carolina Hospitals, Chapel Hill, North Carolina, U.S.A.
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  • Joshua B. Surowitz MD,

    1. Department of Otolaryngology–Head and Neck Surgery, University of North Carolina Hospitals, Chapel Hill, North Carolina, U.S.A.
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  • Mihir R. Patel MD,

    1. Department of Otolaryngology–Head and Neck Surgery, University of North Carolina Hospitals, Chapel Hill, North Carolina, U.S.A.
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  • Benjamin Y. Huang MD,

    1. Department of Radiology, University of North Carolina Hospitals, Chapel Hill, North Carolina, U.S.A.
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  • Carl H. Snyderman MD,

    1. Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
    2. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
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  • Ricardo L. Carrau MD,

    1. Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
    2. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
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  • Amin B. Kassam MD,

    1. Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
    2. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
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  • Anand V. Germanwala MD,

    1. Division of Neurosurgery, University of North Carolina Hospitals, Chapel Hill, North Carolina, U.S.A.
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  • Adam M. Zanation MD

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, University of North Carolina Hospitals, Chapel Hill, North Carolina, U.S.A.
    • Department of Otolaryngology–Head and Neck Surgery, University of North Carolina Memorial Hospitals, 170 Manning Dr., Ground Floor Physician Office Building, CB#7070, Chapel Hill, NC 27599

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  • Presented as a poster at the Triological Society Southern Section Meeting, Bonita Springs, Florida, U.S.A., January 9, 2009.

Abstract

Objectives/Hypothesis:

A prospective study of endoscopic expanded endonasal approaches (EEA) with nasoseptal flap reconstructions revealed anecdotal evidence of less available relative septal length in pediatric patients. Our goal is to use radioanatomic analysis of computed tomography (CT) scans to determine limitations of the nasoseptal flap in pediatric skull base reconstruction and to describe clinical outcomes after using the nasoseptal flap in six pediatric patients.

Study Design:

Six pediatric patients who underwent EEA with nasoseptal flap reconstruction were prospectively analyzed for flap coverage and postoperative cerebrospinal fluid (CSF) leak. Fifty maxillofacial CTs of individuals <18 years of age and 10 adult images underwent radioanatomic analysis.

Methods:

Measurements included potential nasoseptal flap dimensions and dimensions required to reconstruct an anterior skull base defect, a trans-sellar defect, and a transclival defect. Measurements were compared to determine if flap size would be sufficient to cover independent EEA defects within different age groups.

Results:

Two out of three patients <14 years of age had inadequate flap coverage; one had a postoperative CSF leak. Patients >14 years of age had adequate flap coverage. Average potential flap length is less than average anterior skull base length until age 9 years to 10 years, and less than average trans-sellar defect length until age 6 years to 7 years. Septal growth is most rapid between 10 years and 13 years.

Conclusions:

The pedicled nasoseptal flap may not be a viable option for EEA reconstruction in children <10 years of age. This flap is a reliable option in patients >14 years of age, as their septums are comparable to adults. Patients 10 years to 13 years of age require careful consideration of facial analysis and preoperative radioanatomic evaluation on an individual basis. Laryngoscope, 2009

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