Inaccurate Assessments of Anterior Cranial Base Malignancy following Nasoseptal Flap Reconstruction

Objective: The nasoseptal flap (NSF) provides vascularized tissue for repair of skull base defects of various etiologies. However, the NSF repair after skull base resection for anterior cranial base malignancies may demonstrate radiologic findings confusing for recurrent or residual disease on post-operative surveillance imaging. The objective of the current study was to review inaccurate assessments of suspected recurrent cranial base malignancy due to NSF reconstruction during post-operative radiologic evaluations.

Methods: A review of patients reconstructed with the NSF following endoscopic resection of anterior cranial base malignancies by a single otolaryngologist from 2008 to 2012 was performed. Data were collected regarding etiology, surgical technique, locoregional control, and post-operative radiologic assessments. Only patients with at least one post-operative surveillance scan with inaccurate assessment of residual or recurrent malignancy were included in the study.

Results: Over 5 years, 10 patients were identified who had erroneous reporting of malignancy due to NSF reconstruction. On average, 3 neuroradiologists interpreted the NSF as persistent or recurrent malignancy over this time period (range 1–7). The key findings suspicious for recurrence were enhancement and soft tissue thickening of the NSF. These interpretations were present in at least one postoperative scan in all patients.

Conclusion: Neuroradiologists and rhinologists performing surveillance on patients with a history of skull base malignancy with NSF reconstruction should maintain collaborative efforts to accurately interpret radiologic findings of the NSF during postoperative imaging.