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A Novel Reconstructive Technique After Endoscopic Expanded Endonasal Approaches: Vascular Pedicle Nasoseptal Flap

Authors

  • Gustavo Hadad MD,

    1. Department of Otolaryngology–Head & Neck Surgery, Medical School of Ciudad de Rosario, Provincia de Santa Fe, Republica Argentina
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  • Luis Bassagasteguy MD,

    1. Department of Otolaryngology–Head & Neck Surgery, Medical School of Ciudad de Rosario, Provincia de Santa Fe, Republica Argentina
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  • Ricardo L. Carrau MD,

    Corresponding author
    1. Department of Otolaryngology, University of Pittsburgh and the University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania, U.S.A.
    2. Department of Neurological Surgery, University of Pittsburgh and the University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania, U.S.A.
    • Ricardo L. Carrau, MD, FACS, University of Pittsburgh School of Medicine, 200 Lothrop Street, Suite 521, Pittsburgh, PA 15213, U.S.A.
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  • Juan C. Mataza MD,

    1. Department of Neurosurgery, Medical School of Ciudad de Rosario, Provincia de Santa Fe, Republica Argentina
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  • Amin Kassam MD,

    1. Department of Otolaryngology, University of Pittsburgh and the University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania, U.S.A.
    2. Department of Neurological Surgery, University of Pittsburgh and the University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania, U.S.A.
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  • Carl H. Snyderman MD,

    1. Department of Otolaryngology, University of Pittsburgh and the University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania, U.S.A.
    2. Department of Neurological Surgery, University of Pittsburgh and the University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania, U.S.A.
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  • Arlan Mintz MSc, MD

    1. Department of Otolaryngology, University of Pittsburgh and the University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania, U.S.A.
    2. Department of Neurological Surgery, University of Pittsburgh and the University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania, U.S.A.
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Abstract

Background: In patients with large dural defects of the anterior and ventral skull base after endonasal skull base surgery, there is a significant risk of a postoperative cerebrospinal fluid leak after reconstruction. Reconstruction with vascularized tissue is desirable to facilitate rapid healing, especially in irradiated patients.

Methods: We developed a neurovascular pedicled flap of the nasal septum mucoperiosteum and mucoperichondrium based on the nasoseptal artery, a branch of the posterior septal artery (Hadad-Bassagasteguy flap [HBF]). A retrospective review of patients undergoing endonasal skull base surgery at the University of Rosario, Argentina, and the University of Pittsburgh Medical Center was performed to identify patients who were reconstructed with a vascularized septal mucosal flap.

Results: Forty-three patients undergoing endonasal cranial base surgery were repaired with the septal mucosal flap. Two patients with postoperative cerebrospinal fluid leaks (5%) were successfully treated with focal fat grafts. We encountered no infectious or wound complications in this series of patients. One patient experienced a posterior nose bleed from the posterior nasal artery. This was controlled with electrocautery and the flap blood supply was preserved.

Conclusion: The HBF is a versatile and reliable reconstructive technique for defects of the anterior, middle, clival, and parasellar skull base. Its use has resulted in a sharp decrease in the incidence of postoperative cerebrospinal fluid leaks after endonasal skull base surgery and is recommended for the reconstruction of large dural defects and when postoperative radiation therapy is anticipated.

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