Evolution of Radiographic Changes of a Vascularized Pedicled Nasoseptal Flap after Endonasal Endoscopic Skull Base Surgery

• Published in: American journal of neuroradiology : AJNR Vol. 44; no. 2; pp. 171 - 175
• Main Authors: Birkenbeuel, J L, Abiri, A, Nguyen, T, Bitner, B F, Abello, E F, Vasudev, M, Hsu, F P K, Kuoy, E, Kuan, E C
• Format: Journal Article
• Language: English
• Published: United States American Society of Neuroradiology 01-02-2023
• Subjects: Endoscopy - methods; Head & Neck; Humans; Nasal Septum - diagnostic imaging; Nasal Septum - surgery; Plastic Surgery Procedures; Retrospective Studies; Skull Base - diagnostic imaging; Skull Base - surgery; Surgical Flaps - surgery
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A7768

There is active research involving the radiographic appearance of the skull base following reconstruction. The purpose of this study was to describe the radiographic appearance of the vascularized pedicle nasoseptal flap after endoscopic skull base surgery across time.
We performed chart and imaging review of all patients with intraoperative nasoseptal flap placement during endoscopic skull base surgery at a tertiary academic skull base surgery program between July 2018 and March 2021. All patients underwent immediate and delayed (>3 months) postoperative MR imaging. Primary outcome variables included flap and pedicle enhancement, flap thickness, and flap adherence to the skull base.
Sixty-eight patients were included. Flap (
= .003) enhancement significantly increased with time. Mean nasoseptal flap thickness on immediate and delayed postoperative scans was 3.8 and 3.9 mm, respectively (
= .181). The nasoseptal flap adhered entirely to the skull base in 37 (54.4%) and 67 (98.5%) patients on immediate and delayed imaging, respectively (
< .001).
Our findings demonstrate heterogeneity of the nasoseptal flap appearance after skull base reconstruction. While it is important for surgeons and radiologists to evaluate variations in flap appearance, the absence of enhancement and lack of adherence to the skull base on immediate postoperative imaging do not appear to predict reconstructive success and healing, with many flaps "self-adjusting" with time.