Hadad-Bassagasteguy flap in reconstruction of skull base defects after endonasal skull base surgery

Abstract

INTRODUCTIONIn the patients with large dural defects of anterior and ventral skull base, there is a significant risk of postoperative cerebrospinal fluid (CSF) leak. Reconstruction with the vascularised tissue is desirable to facilitate rapid healing, especially in irradiated patients. HadadBassagasteguy flap (HBF), a vascular pedicled flap of the nasal septum mucoperiosteum and mucoperichondrium based on the posterior septal artery (branch of sphenopalatine artery), was first developed in university of Rosario, Argentina, for reconstruction of ventral skull base dural defects.1 It is increasingly becoming a "workhorse" for the reconstruction in extended endonasal skull base surgery. Endoscopic endonasal repair of traumatic CSF leaks with the nasoseptal flap (NSF) has a success rate of approximately 95% -comparable to that of traditional approaches. Methods:We prospectively analyzed the demographic data and the outcome results particularly Post-operative CSF leak in 53 patients who underwent HBF in our hospital from February 2013 to June 2014. The early harvested flap was used to reconstruct anterior skull base defects among patients with high-flow on-table CSF leak. Post-operatively the patients were analyzed for CSF leak and bleeding. Results: Most of the study subjects were between 21-50 years of age (73.6%). The mean age of the study subjects was 41.8±13.8 years. Male/female ratio of the study sample was 1.2 with 29 males and 24 females. Of the total 53 patients 46 (86.8%) has macro defects while 7 (13.2%) had micro defects. Non-secretary lesions were present in 60.4% (32/53) patients while secretary were present in 39.6% (21/53) patients. Cerebrospinal fluid leak was present in all the patients undergoing surgery and majority of them were put on lumbar drain, while bleeding was present in 49.1% patients. Of the total 53 patients only 2 had post-operative cerebrospinal fluid leak (2/53; 3.8%). Conclusions: Use of HB posterior nasal septal flap for reconstruction of anterior skull base among patients with highflow intra-operative CSF leak has a remarkable impact in preventing post-operative CSF leak. Its applicability to wide patient-profiles with respect to age, size of defect, diagnosis is making it a versatile choice of reconstruction after endonasal anterior skull base surgeries.

Assessment of nasal outcomes after endoscopic removal of large midline skull base tumors with nasoseptal flap reconstruction

“…In a study involving twenty-five patients who had expanded endonasal approach (EEA) surgeries with the use of NSF, Wardas et al [21] reported a nonanticipated postoperative CSF leakage in 2 cases. Singh et al [22] assessed 53 patients who received Hadad-Bassagasteguy flap (HBF) to restore anterior skull base lesions among patients with high-flow on-table CSF leak and found that only 2 of the total patients (2/53; 3.8%) experienced a post-operative CSF fluid leak. They concluded that patients with high-flow intraoperative CSF leak can benefit significantly from the use of HB posterior nasal septal flap for rebuilding of anterior skull base.…”