Risk Factors Predicting Nasoseptal Flap Failure in Endoscopic Endonasal Transsphenoidal Approach

Objective: Reconstruction of the skull base using pedicled nasoseptal flap (NSF) seems to be advantageous after endoscopic endonasal transsphenoidal approach (EETSA). There were few reports to evaluate the cause of flap failure in EETSA using NSF. The aim of this study was to evaluate the perioperative risk factors for NSF failure. Methods: The study population comprised of patients who underwent EETSA with NSF elevation between February 2009 and November 2013. We retrospectively reviewed patients' medical records including operative findings. Results: A total of 374 patients (183 men, 191 women) underwent the EETSA and 310 patients underwent the EETSA with NSF elevation including modified nasoseptal rescue flap. The mean patient age was 48.0 years. The total cases of NSF failure were five (overall rate: 1.61%, 5/310; flap elevation: 0.35%, 1/282; flap reconstruction: 14.2%, 4/28). Two patients had diabetes mellitus. One patient had cardiovascular problems. Five patients had old age (mean 70 years, >60). Four patients had postoperative nasal infection. One patient had a radiation therapy. Conclusion: NSF is usually safe and effective technique for skull base reconstruction. However, the condition of diabetes mellitus, cardiovascular problems, an old age, postoperative nasal infection, and radiation therapy must require more attention to improve patient management and NSF survival.