Utility of Rescue Flap in the Reconstruction of Skull Base Defects Following Transnasal Endoscopic Excision of Sellar/Supra-sellar Lesions

Abstract

Background: Naso-septal Rescue Flap(NSRF) technique involves the preservation of unilateral posterior septal artery pedicle without harvesting full Naso-Septal Flap (NSF). This enables usage of NSF flap when needed while allowing enough exposure to resect tumor completely. This also provides with added advantage of tailoring flap according to preference to cover the defect post tumor removal. This technique involves partial harvestation of only the most superior and posterior aspect of the flap to protect its pedicle, providing better instrumentation for the sphenoid sinus. At the end of the procedure, if there is unexpected CSF rhinorrhea or resultant bony defect is large then Nasoseptal flap is harvested from the rescue flap. As very few studies have been conducted for rescue flap technique in anterior skull base defect reconstruction following excision of sellar/supra-sellar lesions, the technique requires further validation, hence the present study is being undertaken. Objectives: • To study the post-operative outcome of Nasal Septal Rescue Flap (NSRF) in terms of donor site morbidity and CSF leak. • To study the post-operative outcome of posterior nasoseptal flap in terms of donor site morbidity and CSF leak. Methodology: A cross-sectional study will be conducted at Department of E.N.T, AVBRH, Sawangi Wardha, during a period of August 2020 to August 2021. A sample size of 20 within 18 -70 years of age with sellar/supra-sellar lesions will be included for the research. Results: The observations obtained will be analyzed statistically and will be discussed in light of literature available. Conclusion: This study will help in formulating the guidelines for the NSF harvest with the goal of preventing unnecessary harvest, thereby decreasing peri-operative and post-operative disadvantages as well as preserving the flap for reconstruction in patients requiring revision surgery.