Garret W Choby 1 , Jose L Mattos 1 , Marion A Hughes 2 , Juan C Fernandez-Miranda 3 , Paul A Gardner 3 , Carl H Snyderman 4 , Eric W Wang 5 Show Affiliations »
Abstract
OBJECTIVES: To assess delayed nasoseptal flaps as a viable reconstructive option for sellar defects, evaluate postoperative vascularity of delayed nasoseptal flaps, and compare cerebrospinal fluid leak and surgery-specific complication rates of primary to delayed nasoseptal flaps. STUDY DESIGN: Case series with chart review. SETTING: University of Pittsburgh Medical Center. SUBJECTS AND METHODS: All patients undergoing transsellar approaches for skull base tumors from 2009 to 2013 were evaluated. In cases where the necessity of a vascularized reconstructive flap was made evident only after tumor resection, the nasoseptal flap was raised after tumor resection and/or cerebrospinal fluid leak development, thus constituting a delayed nasoseptal flap. Outcome measures include postoperative magnetic resonance imaging (MRI) findings, cerebrospinal leak rates, and complication rates. RESULTS: During this timeframe, 437 patients underwent transsellar approaches. Primary nasoseptal flaps were used to reconstruct 179 patients while 32 patients had delayed flaps. All available postoperative MRI scans of delayed nasoseptal flap patients maintained vascularity on examination of T1 postcontrast images. There was no significant difference in cerebrospinal fluid leak rate between primary (3.4%) and delayed flaps (3.1%) (P = .95). There was no significant difference in surgery-specific complication rates between primary flaps (10.6%) and delayed flaps (3.1%; P = .14). Logistic regression analysis demonstrated no significant effect of flap type, age, or sex on cerebrospinal fluid leak rates. CONCLUSION: Delayed nasoseptal flaps are a viable reconstructive option for sellar skull base defects. They maintain vascularity as evidenced on postoperative MRI and are comparable to primary nasoseptal flaps with regard to cerebrospinal fluid leak rates and complication rates. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.
OBJECTIVES: To assess delayed nasoseptal flaps as a viable reconstructive option for sellar defects , evaluate postoperative vascularity of delayed nasoseptal flaps , and compare cerebrospinal fluid leak and surgery-specific complication rates of primary to delayed nasoseptal flaps . STUDY DESIGN: Case series with chart review. SETTING: University of Pittsburgh Medical Center. SUBJECTS AND METHODS: All patients undergoing transsellar approaches for skull base tumors from 2009 to 2013 were evaluated. In cases where the necessity of a vascularized reconstructive flap was made evident only after tumor resection, the nasoseptal flap was raised after tumor resection and/or cerebrospinal fluid leak development, thus constituting a delayed nasoseptal flap. Outcome measures include postoperative magnetic resonance imaging (MRI) findings, cerebrospinal leak rates, and complication rates. RESULTS: During this timeframe, 437 patients underwent transsellar approaches. Primary nasoseptal flaps were used to reconstruct 179 patients while 32 patients had delayed flaps. All available postoperative MRI scans of delayed nasoseptal flap patients maintained vascularity on examination of T1 postcontrast images. There was no significant difference in cerebrospinal fluid leak rate between primary (3.4%) and delayed flaps (3.1%) (P = .95). There was no significant difference in surgery-specific complication rates between primary flaps (10.6%) and delayed flaps (3.1%; P = .14). Logistic regression analysis demonstrated no significant effect of flap type, age, or sex on cerebrospinal fluid leak rates. CONCLUSION: Delayed nasoseptal flaps are a viable reconstructive option for sellar skull base defects. They maintain vascularity as evidenced on postoperative MRI and are comparable to primary nasoseptal flaps with regard to cerebrospinal fluid leak rates and complication rates. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.
Entities: Disease
Species
Keywords:
CSF leak; MRI; complications; delayed; nasoseptal flap; skull base
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Year: 2014
PMID： 25475502 DOI： 10.1177/0194599814561431
Source DB: PubMed Journal: Otolaryngol Head Neck Surg ISSN： 0194-5998 Impact factor: 3.497