Middle Turbinate Vascularized Flap: Applications in Skull Base Reconstruction

Background: The use of local vascularized flaps has had significant impact on postoperative cerebrospinal (CSF) leak rates following endoscopic endonasal skull base surgery (EESBS). The middle turbinate (MT) flap is one alternative for reconstruction of sphenoid and fovea ethmoidalis defects. In select cases, the MT flap is an excellent alternative to the nasoseptal flap.

Objective: We aim to describe our technique and utilization of the MT flap for skull base reconstruction and sinonasal optimization following EESBS.

Methods: We used the MT flap to cover sphenoid and fovea ethmoidalis defects. When necessary, modifications to the original description of the flap were made to tailor the reconstruction to the specific needs of the patient. To date, we have treated five patients with various conditions, including pituitary tumors and spontaneous CSF leaks associated with intracranial hypertension. No postoperative CSF leaks, complications, or crusting related to the flap have been identified.

Conclusions: The MT flap is a safe, effective alternative for skull base reconstruction. Especially for anterior sphenoid or posterior fovea ethmoidalis defects, the MT may offer sufficient repair with the least morbidity.