Nasoseptal Flap for Anterior Skull Base Reconstruction: Our Experience

Introduction: Various endoscopic techniques have been described for reconstructing the anterior skull base to prevent cerebrospinal fluid (CSF) leak. Reconstruction of the barriers separating the subarachnoid space from the sinonasal tract may be the greatest obstacle.

Material and Methods: We retrospectively reviewed the pathological and surgical outcome data of 25 patients who underwent reconstruction of the skull base with the nasoseptal flap (Hadad-Bassagasteguy flap [HBF]) after endoscopic endonasal approach (EEA) from January 2007 to January 2011 at the Departments of Neurosurgery and Maxillofacial Surgery of the University of Rome, “La Sapienza.”

Results: We used the nasoseptal flap in 25 patients, including 10 men and 15 women with ages ranging from 22 to 65 years (mean, 44 years). The largest defect resulted from the resection of the anterior cranial base from the ethmoid sinus to the planum sphenoidale. Only one patient required additional surgery for skull base reconstruction.

Discussion: Synthetic materials have been used extensively, but problems with host-tissue reaction and magnetic resonance imaging interference remain. Autologous grafts interact with the surrounding physiological structures, promoting the migration of fibroblasts and leading to complete recovery of the anatomical barrier.

Conclusion: The HBF is a reliable reconstructive technique for extensive defects of the anterior, clival, and parasellar cranial base. A vascular pedicled flap of the nasal septum mucoperiosteum and mucoperichondrium based on the nasoseptal artery may be harvested and used via an endonasal approach.