Early harvesting of the vascularized pedicled nasoseptal flap during endoscopic skull base surgery

Jean Eloy, Amit A. Patel, Pratik A. Shukla, Osamah J. Choudhry, James Liu

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Purpose The vascularized pedicled nasoseptal flap (PNSF) represents a successful option for reconstruction of large skull base defects after expanded endoscopic endonasal approaches (EEA). This vascularized flap can be harvested early or late in the operation depending on the anticipation of high-flow CSF leaks. Each harvesting technique (early vs. late) is associated with different advantages and disadvantages. In this study, we evaluate our experience with early harvesting of the PNSF for repair of large skull base defects after EEA. Methods A retrospective review was performed at a tertiary care medical center on patients who underwent early PNSF harvesting during reconstruction of intraoperative high-flow CSF leaks after EEA between December 2008 and March 2012. Demographic data, repair materials, surgical approach, and incidence of PNSF usage were collected. Results Eighty-seven patients meeting the inclusion criteria were identified. In 86 procedures (98.9%), the PNSF harvested at the beginning of the operation was used. In 1 case (1.1%), the PNSF was not used because a high-flow intraoperative CSF leak was not encountered. This patient had recurrence of intradural disease 8 months later, and the previously elevated PNSF was subsequent used after tumor resection. Conclusion Based on our data, a high-flow CSF leak and need for a PNSF can be accurately anticipated in patients undergoing EEA for skull base lesions. Because of the advantages of early harvesting of the PNSF and the high preoperative predictive value of CSF leak anticipations, this technique represents a feasible harvesting practice for EEA surgeries.

Original languageEnglish (US)
Pages (from-to)188-194
Number of pages7
JournalAmerican Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume34
Issue number3
DOIs
StatePublished - May 1 2013

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Surgical Flaps
Skull Base
Tertiary Care Centers
Demography
Recurrence
Incidence

All Science Journal Classification (ASJC) codes

  • Otorhinolaryngology

Cite this

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title = "Early harvesting of the vascularized pedicled nasoseptal flap during endoscopic skull base surgery",
abstract = "Purpose The vascularized pedicled nasoseptal flap (PNSF) represents a successful option for reconstruction of large skull base defects after expanded endoscopic endonasal approaches (EEA). This vascularized flap can be harvested early or late in the operation depending on the anticipation of high-flow CSF leaks. Each harvesting technique (early vs. late) is associated with different advantages and disadvantages. In this study, we evaluate our experience with early harvesting of the PNSF for repair of large skull base defects after EEA. Methods A retrospective review was performed at a tertiary care medical center on patients who underwent early PNSF harvesting during reconstruction of intraoperative high-flow CSF leaks after EEA between December 2008 and March 2012. Demographic data, repair materials, surgical approach, and incidence of PNSF usage were collected. Results Eighty-seven patients meeting the inclusion criteria were identified. In 86 procedures (98.9{\%}), the PNSF harvested at the beginning of the operation was used. In 1 case (1.1{\%}), the PNSF was not used because a high-flow intraoperative CSF leak was not encountered. This patient had recurrence of intradural disease 8 months later, and the previously elevated PNSF was subsequent used after tumor resection. Conclusion Based on our data, a high-flow CSF leak and need for a PNSF can be accurately anticipated in patients undergoing EEA for skull base lesions. Because of the advantages of early harvesting of the PNSF and the high preoperative predictive value of CSF leak anticipations, this technique represents a feasible harvesting practice for EEA surgeries.",
author = "Jean Eloy and Patel, {Amit A.} and Shukla, {Pratik A.} and Choudhry, {Osamah J.} and James Liu",
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Early harvesting of the vascularized pedicled nasoseptal flap during endoscopic skull base surgery. / Eloy, Jean; Patel, Amit A.; Shukla, Pratik A.; Choudhry, Osamah J.; Liu, James.

In: American Journal of Otolaryngology - Head and Neck Medicine and Surgery, Vol. 34, No. 3, 01.05.2013, p. 188-194.

Research output: Contribution to journalArticle

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AU - Eloy, Jean

AU - Patel, Amit A.

AU - Shukla, Pratik A.

AU - Choudhry, Osamah J.

AU - Liu, James

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N2 - Purpose The vascularized pedicled nasoseptal flap (PNSF) represents a successful option for reconstruction of large skull base defects after expanded endoscopic endonasal approaches (EEA). This vascularized flap can be harvested early or late in the operation depending on the anticipation of high-flow CSF leaks. Each harvesting technique (early vs. late) is associated with different advantages and disadvantages. In this study, we evaluate our experience with early harvesting of the PNSF for repair of large skull base defects after EEA. Methods A retrospective review was performed at a tertiary care medical center on patients who underwent early PNSF harvesting during reconstruction of intraoperative high-flow CSF leaks after EEA between December 2008 and March 2012. Demographic data, repair materials, surgical approach, and incidence of PNSF usage were collected. Results Eighty-seven patients meeting the inclusion criteria were identified. In 86 procedures (98.9%), the PNSF harvested at the beginning of the operation was used. In 1 case (1.1%), the PNSF was not used because a high-flow intraoperative CSF leak was not encountered. This patient had recurrence of intradural disease 8 months later, and the previously elevated PNSF was subsequent used after tumor resection. Conclusion Based on our data, a high-flow CSF leak and need for a PNSF can be accurately anticipated in patients undergoing EEA for skull base lesions. Because of the advantages of early harvesting of the PNSF and the high preoperative predictive value of CSF leak anticipations, this technique represents a feasible harvesting practice for EEA surgeries.

AB - Purpose The vascularized pedicled nasoseptal flap (PNSF) represents a successful option for reconstruction of large skull base defects after expanded endoscopic endonasal approaches (EEA). This vascularized flap can be harvested early or late in the operation depending on the anticipation of high-flow CSF leaks. Each harvesting technique (early vs. late) is associated with different advantages and disadvantages. In this study, we evaluate our experience with early harvesting of the PNSF for repair of large skull base defects after EEA. Methods A retrospective review was performed at a tertiary care medical center on patients who underwent early PNSF harvesting during reconstruction of intraoperative high-flow CSF leaks after EEA between December 2008 and March 2012. Demographic data, repair materials, surgical approach, and incidence of PNSF usage were collected. Results Eighty-seven patients meeting the inclusion criteria were identified. In 86 procedures (98.9%), the PNSF harvested at the beginning of the operation was used. In 1 case (1.1%), the PNSF was not used because a high-flow intraoperative CSF leak was not encountered. This patient had recurrence of intradural disease 8 months later, and the previously elevated PNSF was subsequent used after tumor resection. Conclusion Based on our data, a high-flow CSF leak and need for a PNSF can be accurately anticipated in patients undergoing EEA for skull base lesions. Because of the advantages of early harvesting of the PNSF and the high preoperative predictive value of CSF leak anticipations, this technique represents a feasible harvesting practice for EEA surgeries.

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