The Nasoseptal Flap for Skull Base Defects: An Institutional Experience

Background: Endoscopic expanded endonasal approaches have become popularized over the past decade for exposure and resection of skull base and intradural lesions. These resections carry with them a significant risk of intraoperative CSF leak and postoperative CSF leaks following reconstruction. A vascularized nasal septal pedicled flap, based on a branch of the posterior septal artery, was developed for reconstruction of these dural defects.

Methods: A retrospective review of patients who underwent endonasal skull base surgery between the years 2005 and 2010 at the University of Toronto was performed to identify patients that were reconstructed with the nasal septal pedicled flap.

Results: Sixty-nine patients had dural defects reconstructed with the nasoseptal flap. Three of these patients had postoperative CSF leaks and one patient had a wound complication.

Conclusion: Within our institution, the use of the nasal septal flap rendered a CSF leak rate of 4%, similar to what has been previously reported in the literature. Given this data, the nasal septal flap has proven to be a reliable reconstructive approach for skull base defects.