Endoscopic Nasoseptal Flap Preservation Approaches to the Cranial Base: An Update to the Jefferson Approach

• Published in: Journal of Neurological Surgery Part B: Skull Base Vol. 77; no. S 01
• Main Authors: Hsu, David, Nyquist, Gurston, Evans, James J., Rosen, Marc, Gill, Kurren S., Rabinowitz, Mindy
• Format: Conference Proceeding Journal Article
• Language: English
• Published: 03.03.2016
• ISSN: 2193-6331; 2193-634X
• DOI: 10.1055/s-0036-1580048

Introduction: The pedicled nasoseptal flap (NSF) is the mainstay for closure after endoscopic anterior cranial base surgery. The NSF is not necessary for repair of all skull base defects as CSF leaks are not always encountered intra-operatively like in the case of pituitary surgery. However, preservation of the NSF is important as it may be required for future use. We present an update to the Jefferson Approach that includes five approaches that protect one or both NSF pedicles while allowing adequate exposure of the cranial base for tumor resection. Methods and Results The approaches include a: (1) strictly unilateral approach; (2) bilateral “modified” rescue flaps (3) a combined transseptal and “modified” rescue flap approach to address septal deflections (4) septal mobilization and transposition; and (5) standard harvest of the nasal septal flap, storage in the nasopharynx, and suturing back in place. Conclusion: The nasoseptal flap is a vital reconstruction option for skull base defects. With the use of these techniques, we identify multiple approaches that allows for bilateral preservation of the nasoseptal flaps.