Pedicled Nasoseptal Flap as Final Layer of Reconstruction for Skull Base Defects

Purpose: Assessment of the efficacy of nasoseptal vascularized flap (NSF) in reconstructing the skull base defects after transsphenoidal procedures and CSF rhinorrhea. Material and Methods: Thirteen patients with intraoperative diagnosis of skull base defects and/or CSF leak after endoscopic transsphenoidal surgery or preoperative diagnosis of CSF rrhinorhea were included in this study. Multilayer reconstruction of skull base was done including duraplasty, skull base bone if necessary and final layer of nasoseptal vascularized pedicled flap (NSF). The NSF is finally fixed and supported in target region with surgicel. Results: Seven cases were of the low flow and two cases of the high flow CSF leak. Four cases had large sellar cavities with prolapsed diaphragma. The technique was successful in preventing postoperative CSF leak immediately in 12 of the 13 cases. The remaining case was managed by ambulant lumber drain with subsequent CSF leak cessation. Sinusitis or epistaxis was not encountered postoperatively in any patient. Nasal encrustations disappeared postoperatively with meticulous follow-up. Conclusion: Our results supports that multilayer reconstruction technique with final NSF layer as described is highly effective in preventing both the low flow and high flow CSF leakage postoperatively.