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Updated: Feb 20, 2026

Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
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Endoscopic Endonasal Reconstructive Methods to the Anterior Skull Base.

Srikant Chakravarthi1, Lior Gonen1, Alejandro Monroy-Sosa1

  • 1Department of Neurosurgery, Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin.

Seminars in Plastic Surgery
|October 28, 2017
PubMed
Summary

Expanded endoscopic endonasal approaches (EEAs) benefit from advanced reconstruction. Vascularized flaps, especially the nasoseptal flap (NSF), effectively repair skull base defects and reduce CSF leaks.

Keywords:
cerebrospinal fluidexpanded endoscopic endonasal approachinferior turbinate flapmiddle turbinate flapnasoseptal flappericranial flaptemporoparietal fascial flap

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Area of Science:

  • Neurosurgery
  • Otolaryngology
  • Head and Neck Surgery

Background:

  • Expanded endoscopic endonasal approaches (EEAs) are increasingly used for anterior skull base, sellar, and parasellar region pathologies.
  • Advancements in reconstructive techniques, particularly pedicled vascularized flaps, have significantly improved outcomes.
  • These flaps effectively cover skull base defects, leading to a notable reduction in postoperative cerebrospinal fluid (CSF) leaks.

Purpose of the Study:

  • To present a simplified reconstruction algorithm for skull base defects following EEAs.
  • To detail the anatomy, indications, contraindications, and surgical techniques for various reconstructive flaps.
  • To emphasize the nasoseptal flap (NSF) as a primary reconstructive option.

Main Methods:

  • Review of current reconstructive techniques for skull base defects after EEAs.
  • Detailed description of the nasoseptal flap (NSF), including its anatomy and surgical application.
  • Description of alternative flaps: inferior turbinate flap (ITF), middle turbinate flap (MTF), pericranial flap (PCF), and temporoparietal fascial flap (TPFF).

Main Results:

  • The nasoseptal flap (NSF) is presented as the primary choice for reconstructing most skull base defects after endoscopic endonasal surgery.
  • The NSF is ideal for defects in the planum, cribriform, and upper two-thirds of the clivus.
  • For the lower third of the clivus, the NSF may require complementary reconstructive strategies.

Conclusions:

  • The nasoseptal flap (NSF) is a versatile and effective option for skull base reconstruction following EEAs.
  • Alternative flaps (ITF, MTF, PCF, TPFF) should be considered when the NSF is inadequate or technically challenging.
  • A comprehensive surgical algorithm incorporating these flaps optimizes reconstruction outcomes.