Object: Expanded endonasal approaches have dramatically changed how skull base surgery is performed, and nasoseptal flap (NSF) has significantly improved skull base reconstruction. However, challenges remain when the pterygopalatine artery is invaded by tumors; when it must be sacrificed to approach the lateral sphenoidal recess; when late-occurrence leak occurs in the sella after transsphenoidal surgery; and also when the leak is on the posterior wall of the frontal sinus, which is too distant for NSF to reach. This article describes a septal floor rotational flap pedicled on ethmoidal arteries for endoscopic skull base reconstruction in certain cases.
Study design: Case series.
Method: In this article, we retrospectively review a series of 19 patients who underwent skull base reconstruction with a septal floor rotational flap pedicled on the ethmoidal arteries.
Result: All 19 flaps, including the anterior and posterior artery pedicled flaps, survived without significant complications, and no postoperative cerebrospinal fluid leak occurred during follow-up.
Conclusion: Ethmoidal arteries pedicled septal floor rotational flap, with their strong blood supply and large coverage area, are ideal replacements for NSF. These flaps are qualified in locations ranging from the posterior wall of the frontal sinus to the lateral sphenoidal recess and in cases ranging from tumor invading the pterygopalatine fossa to sellar late-occurred leak after transsphenoidal surgery.
Level of evidence: 4 Laryngoscope, 129:2696-2701, 2019.
Keywords: Endoscopic endonasal; ethmoidal artery; septal floor rotational flap; skull base reconstruction.
© 2019 The American Laryngological, Rhinological and Otological Society, Inc.