Nasoseptal Flap Enhancement on Early Postoperative MRI Does Not Predict 3-Month Enhancement nor Postoperative Cerebrospinal Fluid Leak Risk.

Publication Title

Neurosurg Pract

Authors

Mehrdad Pahlevani, Pacific Neuroscience Institute, Santa Monica, California, USA.Follow
Artak Mukhaelyan, Pacific Neuroscience Institute, Santa Monica, California, USA.
Keila Angel, Pacific Neuroscience Institute, Santa Monica, California, USA.
Regin Jay Mallari, Pacific Neuroscience Institute, Santa Monica, California, USA.Follow
Chester Griffiths, Pacific Neuroscience Institute, Santa Monica, California, USA.; Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, California, USA.Follow
Daniel F Kelly, Pacific Neuroscience Institute, Santa Monica, California, USA.; Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, California, USA.Follow
Garni Barkhoudarian, Pacific Neuroscience Institute, Santa Monica, California, USA.; Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, California, USA.Follow

Document Type

Article

Publication Date

12-1-2024

Keywords

CSF leak; Endoscopic endonasal surgery; Flap enhancement; Nasoseptal flap; Pituitary surgery; Skull base surgery.; california; santa monica; pni; sjci

Abstract

BACKGROUND AND OBJECTIVES: The nasoseptal flap (NSF) has been a versatile reconstructive option for extended endonasal skull base surgery, significantly decreasing postoperative cerebrospinal fluid (CSF) leakage rates. One failure mechanism of concern is NSF necrosis. It has been postulated that immediate postoperative MRI flap enhancement can predict flap necrosis. This retrospective study analyzes NSF enhancement to assess for flap viability and CSF leakage.

METHODS: Patients from 2012 to 2020 who underwent extended endoscopic endonasal surgery with NSF reconstruction were assessed. Immediate postoperative MRI and delayed 3-month MRI were compared for NSF enhancement. Enhancement was graded as no enhancement, partial, or complete enhancement. Patient demographics, tumor type, intraoperative CSF leak grade, and postoperative CSF leakage were assessed based on flap enhancement patterns.

RESULTS: Of 713 patients who underwent endoscopic endonasal surgery, 64 required NSF reconstruction. On the immediate postoperative MRI, 45 patients (70%) had complete flap enhancement, 9 (14%) had partial, and 10 (16%) no enhancement. On the 3-month MRI, 59 patients (92%) had complete flap enhancement and 5 (8%) had partial enhancement. There was significant improvement of flap enhancement between immediate postoperative and 3-month MRI (

CONCLUSION: Overall, immediate postoperative MRI NSF enhancement (or lack thereof) did not predict enhancement at the 3-month MRI and did not correlate with postoperative CSF leakage. Hence, one should not rely solely on postoperative flap enhancement to assess the viability of the dural reconstruction.

Area of Special Interest

Neurosciences (Brain & Spine)

Specialty/Research Institute

Neurosciences

Specialty/Research Institute

Surgery

DOI

10.1227/neuprac.0000000000000118