Radioanatomic study of the skull base and septum in Asians: implications for using the nasoseptal flap for anterior skull‐base reconstruction

Park, Sung‐Joon; Kim, Hyun Jik; Kim, Dong Young; Rhee, Chae Seo; Paek, Sun Ha; Won, Tae Bin

doi:10.1002/alr.21993

Cited by 3 publications

(7 citation statements)

References 16 publications

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“…It is known to skull base surgeons that the length of the flap can be inadequate when ASB defect is reconstructed with routine PNSF. To identify this, there are some cadaveric and radioanatomic studies on PNSF and ASB reconstruction [ 1 , 8 , 9 , 12 – 15 ]. However, in most of these studies, the ASB reconstruction was performed without sphenoidotomy, and therefore the findings cannot be applied to EEAs for large ASB lesions requiring sphenoidotomy [ 1 , 9 , 10 , 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…The expected PNSF excess at the limbus of the sphenoid bone is important for the preoperative planning of EEAs to access the sella, tuberculum sella, and planum sphenoidale. In a Korean population study [ 8 ], the mean length of the planum sphenoidale was 1.26 ± 0.33 cm. Therefore, the PNSF could provide coverage up to around the planum sphenoidale in the EEAs with total sphenoidotomy considering the intraoperative shrinkage of the PNSF.…”

Section: Discussionmentioning

confidence: 99%

“…Our study showed successful coverage of the ASB over the posterior wall of the frontal sinus using PNSF in all patients without total sphenoidotomy. Some other studies have indicated that CPFS of ≤0.5 cm could be a risk factor for insufficient coverage for reconstruction [ 8 , 9 , 14 ]. In our cadaveric study without sphenoidotomy, the CPFS was ≤0.5 cm in 6 out of the 15 specimens (40%), unlike in some other studies that used Western cadavers and showed a lower rate of CPFS of ≤0.5 cm [ 7 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…The theoretical anterior limit of the ASB is the posterior wall of the frontal sinus [ 7 ]. Some studies on the feasibility of using a PNSF for ASB reconstruction have measured the distance from the anterior border of the planum sphenoidale to the posterior wall of the frontal recess [ 8 , 9 ]. These studies were based on the assumption that the ASB defect is not as large as to perform the sphenoidotomy.…”

Section: Introductionmentioning

confidence: 99%

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Anterior skull base reconstruction using nasoseptal flap: Cadaveric feasibility study and clinical implication [SevEN-001]

Sung

Lim

et al. 2020

Journal of Otolaryngology - Head & Neck Surgery

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Background Pedicled nasoseptal flap (PNSF) has significantly improved the surgical outcomes of endoscopic endonasal approach (EEAs) by reducing cerebrospinal fluid (CSF) leakage. The purpose of this study is to assess the feasibility of using a PNSF for anterior skull base (ASB) reconstruction and to describe a method to compensate for a short flap based on our results. Methods In this cadaveric study, ASB dissection without sphenoidotomy was performed using 10 formalin-fixed and 5 fresh adult cadaver specimens, and the sufficiency of the PNSF to cover the ASB was assessed. After the sphenoidotomy, the length by which the PNSF fell short in providing coverage at the posterior wall of the frontal sinus (CPFS), and the extent of the anterior coverage from the limbus (CL) of the sphenoid bone was measured. Results Without sphenoidotomy, the mean length of the remaining PNSF after the coverage of the posterior wall of the frontal sinus was 0.67 cm. After sphenoidotomy, the PNSF fell short by a mean length of 2.10 cm, in providing CPFS. The CL was 1.86 cm. Based on these findings, defects resulting from an endoscopic resection of ASB tumors were reconstructed using PNSF without total sphenoidotomy in 3 patients. There were no postoperative CSF leaks or complications. Conclusions The use of PNSF for ASB reconstruction may be insufficient to cover the entire ASB defect after removal of large lesions which need total sphenoidotomy. When possible, by leaving some portion of the anterior sphenoid wall for supporting the PNSF, successful ASB reconstruction could be achieved in endoscopic resection of ASB tumors. Additional methods might be needed in some cases of large ASB lesions wherein the anterior sphenoid wall should be removed totally and the ASB defect is too large.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Anterior skull base reconstruction using nasoseptal flap: Cadaveric feasibility study and clinical implication [SevEN-001]

Sung

Lim

et al. 2020

Journal of Otolaryngology - Head & Neck Surgery

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“…The Brescia group detail the anatomy of the anterior superior alveolar nerve (ASAN) as it relates to medial maxillectomy as well as techniques for minimizing long‐term morbidity from this complication. Park et al . evaluate the radiographic anatomy of the Asian nose as it relates to sphenopalatine flap skull‐base closure.…”

mentioning

confidence: 99%

Quality improvement in rhinology

Kennedy¹

2017

Int Forum Allergy Rhinol

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Pneumatization of the Sphenoidal Sinus May Affect Endonasal Cranial Base Reconstruction

Ramos

Pinheiro‐Neto

Possatti

2022

Journal of Craniofacial Surgery

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Objective: The aim of this study is to verify if the length of the nasoseptal flap is sufficient to cover the tuberculum sellae and planum sphenoidale of sphenoidal sinuses with varied degrees of pneumatization Methods: Retrospective study of paranasal sinus computed tomography comparing the potential length of the nasoseptal flap and the length of the nasoseptal flap required for reconstruction of transtuberculum and transplanum approaches in conchal, presellar, sellar, incomplete postsellar, and complete postsellar sphenoidal sinuses Results: The length of the nasoseptal flap required for reconstruction of transtuberculum and transplanum approaches was directly related to the degree of pneumatization of the sphenoidal sinus. The nasoseptal flap length was adequate to cover the cranial base after transtuberculum approaches of all cases from the conchal, presellar, and sellar groups and the majority of cases from postsellar pneumatization. For transplanum approaches, the nasosseptal flap was sufficient to reconstruct defects in most cases from conchal, pre-sellar, and sellar type sinuses and in 54,9% and 19,2% in incomplete and complete postsellar, respectively. Conclusions: In well pneumatized sphenoidal sinus, the nasoseptal flap may not be sufficient to cover the cranial base after transtuberculum and transplanum approaches.

show abstract

Radioanatomic study of the skull base and septum in Asians: implications for using the nasoseptal flap for anterior skull‐base reconstruction

Cited by 3 publications

References 16 publications

Anterior skull base reconstruction using nasoseptal flap: Cadaveric feasibility study and clinical implication [SevEN-001]

Anterior skull base reconstruction using nasoseptal flap: Cadaveric feasibility study and clinical implication [SevEN-001]

Quality improvement in rhinology

Pneumatization of the Sphenoidal Sinus May Affect Endonasal Cranial Base Reconstruction

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