Hadad-Bassagasteguy flap in skull base reconstruction - current reconstructive techniques and evaluation of criteria used for qualification for harvesting the flap.

Abstract

Introduction Cerebrospinal fluid (CSF) leakage is a common consequence or complication in the operations of skull base tumors. The Hadad-Bassagasteguy flap (HBF) is the most common local flap used in the reconstruction of the meninges. It is a nasoseptal flap (NSF) vascularized by the sphenopalatine artery (SPA). Improvement of the already existing techniques is necessary. Aim To present our experience in HBF and to evaluate the criteria used for qualification (relative and absolute indications) for the NSF reconstructive technique. Material and methods The retrospective study included 25 patients who underwent expanded endonasal approach (EEA) operations with the NSF. The correctness of qualification based on our own criteria was assessed. The most important modifications of the original HBF as well as the reasons for failures are discussed. Results There were 12 relative and 13 absolute indications for NSF harvesting. In 2 cases no anticipated CSF leakage was observed. No complications were reported. Conclusions Skull base reconstruction with HBF and its various modifications is a highly effective technique. Absolute indications for NSF harvesting prior to resection are: reoperations in the case of a previous open approach, preoperative CSF leakage, intradural localization of a tumor related to its etiopathogenesis, suspicion of intradural diffusion of a neoplasm in magnetic resonance imaging if the etiopathogenesis cannot clarify the tumor’s relation to the meninges. Relative indications concern mostly pituitary macroadenomas of at least 2.5 cm in diameter.

An institutional analysis of the outcomes of endonasal endoscopic anterior skull base surgery

“…If there is a significant suprasellar extension of a lesion, the floor of the sphenoid sinus can be drilled back to the clivus. [7][8][9] Neoplasms that most commonly occupy the orbital apex and can be treated by the transnasal endoscopic approach (TEA) include cavernous hemangioma, schwannoma, and fibrous dysplasia. 5 Petrous apex lesions may remain undetected for extended periods because patients often complain of vague or indistinct symptoms that delay diagnosis.…”

“…The following flaps can be used: tunneled temporoparietal fascia flap, endoscopic-assisted pericranial flap, palatal flap, occipital flap, facial artery buccinator flap, and others. [7][8][9][10] As EEA uses the sino-nasal tract as the surgical corridor to the skull base, sino-nasal trauma is a primary source of postoperative morbidity in many patients. Though most sino-nasal morbidities are transient and resolve within several months, symptoms can persist for longer with more complex surgeries, 6,11,12 The complication which occurs due to endonasal surgery can be classified on the basis of the time duration after which they occur.…”

Olfaction after endoscopic surgery for sellar and parasellar disease: an updated systematic review and meta-analysis

“…Whether NSF elevation increases the risk of olfactory deficit after endoscopic surgery for sellar/parasellar lesions is not fully clear. Our subgroup meta-for a vascularized graft which could enhance reconstruction as compared to free grafting (44,45) . Elevation of the NSF involves cutting in the superior septal mucosa, which is associated with an increased chance of nasal crusting (17) .…”

A review of common endoscopic intracranial approaches

“…The rates of postoperative CSF leaks have declined with the use of vascularized tissue for reconstruction of the skull base, such as the Hadad-Bassagasteguy flap. [ 41 ] Other less frequent complications are transient and permanent neurologic deficits and intracranial infections. On the whole, endoscopic endonasal skull base surgery provides a viable access point to a variety of skull base lesions, and the safety profile will continue to improve with acquisition of surgical skills and experience.…”