Optimizing skull base defect repair: leveraging the reused nasoseptal flap as a reliable material.

Abstract

Purpose: The escalating number of endoscopic skull base procedures necessitates exploring additional materials to reduce postoperative cerebrospinal fluid (CSF) leaks in revision or staged surgeries. This study evaluates the effectiveness of reused nasoseptal flaps (NSFs) in such clinical scenarios.

Methods: A retrospective review was conducted on patients who previously underwent surgery involving NSFs and later had revision or secondary skull base surgeries via endoscopic endonasal approaches (EEAs) at a tertiary medical center. Patients were divided into two groups: one with reused NSFs and the other without. Demographics, intraoperative CSF leaks, reconstruction materials, postoperative morbidity, and time to complete mucoepithelialization of the defect were analyzed.

Results: The study included 20 patients with prior NSF usage who underwent secondary EEAs. Thirteen cases utilized reused NSFs alone or with inlay fat or fascia lata, while the remaining seven employed other materials. Pathology type disparity was significant (p = 0.031). Reused NSF demonstrated a 100% success rate in reducing CSF leaks. The average time for mucoepithelization was 61 days (SD = 34 days).

Conclusions: Reusing NSF in revision or staged surgeries is a reliable technique for skull base repair, potentially reducing nasal morbidity and obviating the need for harvesting other vascular flaps.