Using Indocyanine Green Fluorescence Angiography to Evaluate the Impact of Surgical and Patient Factors on Vascular Perfusion of Nasoseptal Flaps in Endoscopic Skull Base Surgery

Background: The reconstructive nasoseptal flap (NSF) is heavily utilized in endonasal skull base surgery (ESBS). We used indocyanine green (ICG) fluorescence angiography to assess how patient and intraoperative factors influence NSF pedicle perfusion.

Methods: We prospectively enrolled patients undergoing ESBS. Intravenous ICG was administered intraoperatively at two times: start of case and immediately following reconstruction. At each time point, mean ICG fluorescence intensity (FI) of NSF pedicles at the region of the posterior septal artery was captured using near-infrared endoscopy and quantified using Image J analysis software. Several factors were studied: patient demographics, comorbidities, prior sinonasal surgical history, surgical approach, timing of flap harvest, concurrent septoplasty, and flap-related complications. T-test was used to evaluate for significant differences in ICG baseline and changes from baseline.

Results: 54 patients were studied. Overall, mean FI changed from baseline 118.1 ± 28.6 to 114.4 ± 32.3 following reconstruction. Tobacco smokers had lower baseline FI compared to nonsmokers (78.3 ± 62.8 vs. 118.4 ± 29.1, p = 0.003). Patients who underwent a transpterygoid approach had a greater decrease from baseline (−25.8 ± 58.9 vs. −3.8 ± 32.1, p = 0.035). No other studied factors, including revision case, timing of flap harvest, division of palatosphenoidal artery, or concurrent septoplasty, had a significant influence on ICG intensity. There was 1 case of flap necrosis, however FI did not significantly differ for this case. The positive predictive value of ICG enhancement for flap viability was 96.6%.

Conclusion: Tobacco use and transpterygoid approaches may be associated with decreased vascular perfusion of NSFs.

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Artikel online veröffentlicht:
05. Februar 2024