Endoscopic reconstruction of skull base defects with the nasal septal flap.

OBJECTIVES: Endoscopic technology is allowing larger resections of the anterior and middle skull base with resultant dural defects. A pedicled nasal septal flap (NSF) based on the posterior nasal septal artery has recently been developed for closure of these defects. We describe our initial experience with the NSF for vascularized coverage of skull base defects.

DESIGN: Retrospective review.

SETTING: Tertiary care skull base center.

PARTICIPANTS: Patients undergoing endoscopic harvest of vascularized pedicled flap for skull base reconstruction.

RESULTS: Twenty-eight patients had 32 NSFs raised over 14 months for benign (7) or malignant (21) lesions. Surgical defects (mean, 4.95 cm(2)) were intracranial (25) and intradural (20, average defect 1.86 cm(2)) in the anterior (10) and central skull base (6), infratemporal fossa (4), orbit (1), or a combination of sites (9). There were no cases of meningitis or cerebrospinal fluid leak (median follow-up, 8.3 months). Two NSFs were injured intraoperatively and two necrosed postoperatively, both in patients with a prior history of radiation to the nasopharynx (p = 0.013).

CONCLUSIONS: Prior radiation is a risk factor for necrosis. The NSF is easily harvested endonasally, reliably covers a range of skull base defects, and should be considered the first line closure after expanded endonasal skull base resections.