Vascularized Nasal Septal Flaps for Reconstruction of Central Skull Base Defects

Surgical resection of central skull base tumors presents the challenge of reconstructing the critical barriers that separate the brain and the carotid and basilar arteries from the contaminated spaces of the nose and sinuses. When reconstruction is insufficient, disastrous outcomes may include CSF leakage, meningitis, and carotid or basilar artery rupture. With increasing use of endoscopic and minimal-access resection techniques, a method of reliable reconstruction using locally available, vascularized tissues is highly desirable. We offer a method for central skull base reconstruction using a nasal septal flap that is pedicled and vascularized, suitable for resurfacing defects of the clivus, sphenoid sinus, nasopharynx, and adjacent areas. The anatomic basis for such a flap, along with variations and clinical examples, will be presented.