Ipsilateral Nasoseptal Flap Pedicle for Transpterygoid Approach: Technical Note

Area of Science:

• Neurosurgery
• Skull Base Surgery
• Endoscopic Endonasal Surgery

Background:

• The transpterygoid approach, an expanded endonasal approach (EEA), provides access to the infratemporal fossa and skull base.
• This approach often necessitates sacrificing the sphenopalatine artery, requiring contralateral flaps for reconstruction.
• Alternative reconstructive techniques are thus needed.

Purpose of the Study:

• To describe a technique for preserving the ipsilateral nasoseptal vascular pedicle during the transpterygoid approach.
• To report a case of spontaneous cerebrospinal fluid (CSF) leak repair using this technique.
• To review the literature on preserving the sphenopalatine artery in skull base surgery.

Main Methods:

• A case of spontaneous CSF leak due to sphenoid sinus meningo-encephalocele was treated.
• An ipsilateral nasoseptal flap was harvested.
• The sphenopalatine artery was preserved during the transpterygoid approach.

Main Results:

• The surgical technique for preserving the ipsilateral nasoseptal vascular pedicle during the transpterygoid approach is described.
• Successful skull base reconstruction was achieved using the ipsilateral nasoseptal flap.
• The sphenopalatine artery was preserved throughout the procedure.

Conclusions:

• The transpterygoid approach allows wide exposure of the pterygoid base while preserving the sphenopalatine artery.
• Ipsilateral nasoseptal flap can be utilized for skull base reconstruction in these cases.
• Preservation of the sphenopalatine artery simplifies reconstruction and avoids contralateral flap harvesting.