• Murat Kutlay, Ozan Durmaz, Alparslan Kırık, Soner Yaşar, İlker Özer, Mehmet Can Ezgü, Cahit Kural, Çağlar Temiz, Abdullah Durmaz, Mehmet Kadri Daneyemez, and Yusuf Izci.
• Department of Neurosurgery, University of Health Sciences, Gulhane School of Medicine, Ankara, Turkey.
• World Neurosurg. 2020 Jan 1; 133: e503-e512.

BackgroundThe pedicled nasoseptal flap (NSF) constitutes the primary reconstructive option for most skull base defects in endonasal endoscopic approaches. The superior nasal turbinate (ST) has received little attention. We report our preliminary experience with the use of the ST mucosal flap in selected cases.MethodsWe performed a retrospective review of patients who underwent endonasal endoscopic approaches and identified 9 patients who were reconstructed with vascularized ST mucosal flaps as part of a double-layer or triple-layer reconstruction. When there was no intraoperative cerebrospinal fluid (CSF) leak, we used a double-layer technique. If there was an intraoperative CSF leak, regardless of the quality of leakage, we preferred a triple-layer repair technique. In patients with high-flow leaks, triple-layer repair was performed using only autologous tissue grafts and flaps.ResultsIntraoperative CSF leaks were noted in 7 of 9 patients. Among them, 4 patients had low-flow CSF leaks (grade 1 and 2) and 3 patients had high-flow CSF leaks (grade 3). All reconstructions had complete defect coverage with the ST flaps and NSFs were preserved. All the flaps were viable at 4 weeks without a CSF leak or complication at the reconstruction site. There was no contraction or partial loss of the flap. After a mean follow-up period of 9 months, none of the patients required a flap revision, developed a mucocele, infection, or other complication.ConclusionsAn ST flap can be used for the vascularized reconstruction of sellar defects if it is bilaterally available. This option should not be overlooked and wasted.Copyright © 2019 Elsevier Inc. All rights reserved.

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