• Woori Park, Sang Duk Hong, Do-Hyun Nam, Doo-Sik Kong, Gwanghui Ryu, Hyo Yeol Kim, Seung-Kyu Chung, and Hun-Jong Dhong.
• Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
• World Neurosurg. 2016 Sep 1; 93: 164-7.

ObjectiveThe nasoseptal flap (NSF) has been shown to be a mainstay in the reconstruction of skull base defects. We evaluated the efficacy and complications of NSF in patients with a history of septal surgery who had the potential risk of tearing and poor vascularity.MethodsWe performed a retrospective chart and video review of patients who underwent NSF for skull base reconstruction between February 2012 and May 2015. Comparison was made between 18 patients (revision group) who had a history of septoplasty and/or transseptal transsphenoidal approach and 88 patients (primary group) without a history of septal surgery. Laceration when raising the flap, vascularity on postoperative magnetic resonance imaging, viability on postoperative endoscopy, and cerebrospinal fluid (CSF) leakage were compared between the revision and primary groups.ResultsLaceration of the flap occurred during NSF elevation in 2 patients (11.1%) in the revision group and 4 patients (4.5%) in the primary group (P = 0.269). Poor flap vascularity on magnetic resonance imaging was observed in 2 patients (11.1%) in the revision group and 8 patients (9.1%) in the primary group (P = 0.674). The rate of flap necrosis on endoscopy was 5.6% in the revision group and 1.1% in the primary group (P = 0.312). There was no significant difference in CSF leakage rate between the 2 groups (revision 5.6% and primary 10.2%).ConclusionsThere was no difference in rate of CSF leakage or flap integrity between the 2 groups. Therefore, NSF for skull base reconstruction is feasible in patients with a history of septal surgery.Copyright © 2016 Elsevier Inc. All rights reserved.

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