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

Abstract

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.

Feasibility of a septal mucosal flap for preventing re-stenosis following the Draf III procedure

“…Nasoseptal flaps based on the posterior nasoseptal artery, as defined by Hadad et al, have been used with various aims in endoscopic surgery. 5 To the best of our knowledge, such flaps have never been placed after an endoscopic modified Lothrop procedure for preventing re-stenosis. Jones et al used this flap for resurfacing frontal defects, such as after cerebrospinal fluid leak, in 2012.…”

“…The neurovascular pedicled flap of the nasal septum was based on the nasoseptal artery, a branch of the posterior septal artery described by Hadad et al (Figure 2). 5 In order to achieve the longest size of flap, the vertical incision of the flap was carried out at the distal edge of septal cartilage. Thereafter, the mucoperichondrium and the mucoperiosteal flap were elevated and preserved posteriorly in the nasopharyngeal area (Figure 3).…”

Tactics of reconstructive closure of basal defects after resection of midline tumors of the anterior skull base (a literature review)

“…Слизисто-надкостничный лоскут перегородки носа, известный как «лоскут по Hadad», произвел революцию в эндоскопической хирургии основания черепа -частота ликвореи снизилась с 40-50% до 5% [15]. Это идеальный лоскут для использования в эндоскопической хирургии основания черепа (см.…”

Transsphenoidal endoscopic skull base surgery: state of the art and future perspective

“…Large defects (Grade 3) are typically seen only in extended suprasellar approaches, for example, removal of suprasellar craniopharyngiomas or tuberculum sella meningiomas. In such cases, the repair consists of virtually the same construct utilized for a Grade 2 leak with the addition of a vascularized nasoseptal flap ( Figure 14 ) held in place with bilateral nasal tampons for 5 days [ 54 ]. Addition of 48 h of lumbar CSF diversion is also often used for these large Grade 3 defects.…”

“…The initial approach to the sphenoid sinus is performed normally by the otolaryngologist with a 0 ° 4-mm endoscope. As described below, we rarely utilize a vascularized nasoseptal flap [ 54 ] for reconstruction and CSF leak repair for cases of pituitary adenoma and RCC. Instead, we elevate bilateral " rescue " flaps preserving the arterial pedicle should a nasoseptal flap-based reconstruction become necessary [ 111 ].…”