Use of Endoscopic Vascularized Nasoseptal Flap in Children

Objective: 1) Determine ability to achieve 100% coverage of sellar skull base defects with the vascularized nasal septal flap in pediatric patients. 2) Identify the rate of residual CSF leaks following this repair technique in these pediatric patients. 3) Review the demographics and perioperative course in these children. Method: Study design: Retrospective case series. Study conducted: January 1, 2006, to January 1, 2012. Condition studied: Repair of skull base defects after resection of sellar lesions. Subjects: Children. Setting: Children’s hospital. Intervention: Endonasal repair of skull base defects with a vascularized nasoseptal flap. Outcome measurement(s): 1) Complete coverage of defect. 2) Postoperative CSF leak. Results: Demographics: Ten children were identified, and 11 flaps were performed. The average patient age was 12.6 years old (range of 5.1-17.4 years). Total coverage was achieved in all cases. The technique was particularly challenging in the younger patients. A brisk CSF leak was observed during closure in 3 cases, but no CSF leaks were observed after balloon packing removal (day 5). No lumbar drains were used. Only minor complications were observed. A second look with debridement of packing material due to poor cooperation with office endoscopy was done in 7 children (70%). Conclusion: The endonasal vascularized nasal septal flap is a feasible and reliable method of repair of dural defects after resection of sellar lesions in children. Despite active CSF leak in 3 children, there were no residual CSF leaks. Unlike adult patients, children may require operative nasal debridement after repair has healed.