Nasoseptal Flap Reconstruction of Pediatric Sellar Defects: A Radiographic Feasibility Study

Abstract

Objectives:

Computed tomography (CT) measurements were used to investigate the feasibility of performing vascularized nasoseptal flap reconstruction of sellar defects in children.

Methods:

Ten CT scans from children of each year of age from birth to 18 were obtained for 190 total subjects. Patients with incomplete pneumatization were excluded from analysis. Measurements of nasoseptal flap and sellar defect length were obtained for each subject using OSIRIX radiology software. Reconstruction was presumed feasible if the ratio of nasoseptal flap length to associated sellar defect length was greater than 1.

Results:

Of the 190 CT studies, 125 displayed complete pneumatization. Of these, 120 (96%) displayed a ratio of nasoseptal flap length to sellar defect length greater than 1, suggesting feasibility of flap reconstruction. Mean ratio of nasoseptal flap length to sellar defect length for all subjects was 1.47 (SD = 0.33) with 95% CI [1.41, 1.53]. Only 5 patients (4%) had inadequate nasoseptal flaps; mean age for these patients was 14.8 years (SD = 2.9), which is older than mean age of 11.6 years (SD = 4) for subjects with adequate measurements. The mean age difference did not meet significance with t-test (P = .069), likely due to the small number of patients with inadequate flaps. An inverse relationship was identified between age and ratio of nasoseptal flap length to sellar defect length (Pearson correlation coefficient –0.49).

Conclusions:

Flap length is not a limiting factor in nasoseptal flap reconstruction of sellar defects in children. Younger patients have higher ratios of nasoseptal flap length to sellar defect length than older patients.