Septal Flap for Reconstruction of the Skull Base Defect

Abstract

Objective: The pedicled septal flap (SF) is one of the most valuable methods to reconstruct the surgical defect after endoscopic skull base surgery. We aimed to assess the feasibility of the SF for reconstruction of the entire anterior SBD in Koreans and attempted to provide tips for improving its design.

Method: CT scans of 2 patients with olfactory neuroblastoma awaiting endoscopic CFR were analyzed. Specific skull base landmarks were measured to estimate the potential anterior SBD. The length and width of the potential SF dimension was also measured. Actual intraoperative defect size and reconstruction method were also compared.

Results: The maximal width and length of the potential anterior SBD was 17.62 to 24.63 mm, and 33.49 to 33.61 mm, respectively. The potential width and length of the sepal flap was 40.14 to 45.21 mm, and 55.43 to 60.87 mm, respectively. According to the radioanatomic studies, the calculated lengths of SF were sufficient to cover the anticipated anterior SBDs in all subjects. All subjects were underwent endoscopic craniofacial resection for anterior skull base lesion, and reconstructed with SF. Actual size of the defect was 20.06 x 13.71 mm and 26.80 x 33.44 mm, respectively.

Conclusion: Preoperative radioanatomic analysis is helpful in anticipating SBD and subsequent planning of the SF design. Increasing flap length by extending the anterior incision to the caudal septum and increasing flap width by incorporating the mucoperiosteum of the nasal floor can compensate for the relatively small septum in Asians.