Janus flap: Bilateral nasoseptal flaps for anterior skull base reconstruction
This article was presented at the 2009 AAO–HNSF Annual Meeting & OTO EXPO, San Diego, CA, October 4-7, 2009.
Received 10 September 2009; received in revised form 7 November 2009; accepted 8 December 2009.
Abstract
Objective
Large dural defects after extended endoscopic endonasal skull base resections require meticulous reconstruction to prevent a cerebrospinal fluid leak postoperatively. The nasoseptal flap is a vascularized tissue graft developed to aid in the multilayer reconstruction of the skull base. The purpose of this study is to describe the first experiences with bilateral nasoseptal flaps for reconstruction of very large skull base defects.
Study Design
Prospective, observational study.
Setting
Large tertiary referral center (New York Presbyterian Hospital).
Subjects and Methods
Five patients underwent a multilayer reconstruction after an extended endoscopic transsphenoidal skull base surgery that included bilateral nasoseptal flaps. Pathologies consisted of two pituitary macroadenomas, one planum sphenoidale meningioma, one craniopharyngioma, and one cavernous sinus hemangioma.
Results
All five patients underwent successful skull base reconstruction without a cerebrospinal fluid leak, complication at the reconstruction site, or anterior extension of the posterior septal perforation.
Conclusion
Bilateral nasoseptal flaps are a viable option for large dural defects of the anterior and ventral skull base when one nasoseptal flap may not completely seal the entire defect.
aDepartment of Otorhinolaryngology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
bDepartment of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
Corresponding author: Gurston G. Nyquist, MD, 772 Park Avenue, New York, NY, 10021
No sponsorships or competing interests have been disclosed for this article.
ABSTRACT