Anatomical study in human cadavers of the pedicled nasoseptal flap for endoscopic anterior skull base reconstruction

Abstract

The skull base surgery has evolved in recent years. Technological progress is responsible for the substitution of aggressive approaches to less invasive approaches to skull base tumors. Using endoscopes and powered surgical instrumentation, it is possible to remove deep skull base lesions without craniotomy and brain retraction. However, the endoscopic reconstruction of the resultant defect became a limiting factor for the development of this technique. The post-operative CSF leak rate after endoscopic approaches was very superior when compared with the rate after traditional approaches. After 2003, the use of pedicled nasoseptal flap for endoscopic skull base reconstruction improved the results of the endoscopic approches and the rate of post-operative CSF leak became similar to that observed with open surgeries. However, there is an important disadvantage of the pedicled septal flap. It has to be harvested before the surgeon knows the real defect size that has to be reconstructed. So, anatomic studies about the flap dimensions are important for the harvest standardization. There is no cadaveric anatomic study about the flap dimension, its vasculature and potential skull base defects after endoscopic approaches. (AU)