Inaccurate Assessments of Anterior Cranial Base Malignancy Following Nasoseptal Flap Reconstruction

Abstract

Objective The nasoseptal flap (NSF) provides vascularized tissue for repair of skull base defects of various etiologies. However, the NSF repair after skull base resection for anterior cranial base malignancies may demonstrate radiologic findings confusing for recurrent or residual disease on postoperative surveillance imaging. The objective of the current study was to review neuroradiologic misinterpretations of NSF reconstruction following anterior cranial base malignancies. Methods A multicenter review of patients reconstructed with the NSF after endoscopic resection of anterior cranial base malignancies from 2008 to 2013 was performed. Data were collected regarding etiology, surgical technique, locoregional control, and postoperative radiologic assessments. Only patients with at least one postoperative surveillance scan with inaccurate assessment of residual or recurrent malignancy were included in the study. Results Over 5 years, 13 patients were identified who had erroneous reporting of malignancy due to NSF reconstruction. On average, two neuroradiologists interpreted the NSF as persistent or recurrent malignancy over this time period (range: 1-7). The key findings suspicious for recurrence were enhancement and soft tissue thickening of the NSF. These findings were present in at least one postoperative scan in all patients. Conclusion Neuroradiologists and rhinologists performing surveillance on patients with a history of skull base malignancy with NSF reconstruction should maintain collaborative efforts to accurately interpret radiologic findings of the NSF during postoperative imaging.

The Use of Polydioxanone Plates for Endoscopic Skull Base Repair

“…For this reason, radiologists need to be aware of the material used in the repair. 30 In cases in which revision surgery is required for tumor recurrence or CSF leak repair, osteoneogenesis must be taken into consideration and dealt with accordingly. The material of the plate was absorbed safely, with no evidence of granulation at the repair site.…”

ICAR: endoscopic skull‐base surgery

“…Other potential recipient site complications include incorrect orientation of the mucosal surface of the flap against the skull‐base defect, delayed mucocele formation under the flap, and a risk for misinterpretation of the vascular reconstruction as disease persistence or recurrence on surveillance imaging …”

Complications of Nasoseptal Flap Reconstruction: A Systematic Review

“…It is important not to confuse postoperative NSF enhancement on MRI with tumor residual/recurrence. 36 Prior septal surgery does not jeopardize NSF vascularization. 37 The axial pattern of vascularization is preserved postseptoplasty, and secondary NSF harvest with revision cases, as flap take-down and reuse, has been shown to be safe and reliable.…”