Abstract
Objective The nasoseptal flap (NSF) provides vascularized tissue for repair of skull base defects
of various etiologies. However, the NSF repair after skull base resection for anterior
cranial base malignancies may demonstrate radiologic findings confusing for recurrent
or residual disease on postoperative surveillance imaging. The objective of the current
study was to review neuroradiologic misinterpretations of NSF reconstruction following
anterior cranial base malignancies.
Methods A multicenter review of patients reconstructed with the NSF after endoscopic resection
of anterior cranial base malignancies from 2008 to 2013 was performed. Data were collected
regarding etiology, surgical technique, locoregional control, and postoperative radiologic
assessments. Only patients with at least one postoperative surveillance scan with
inaccurate assessment of residual or recurrent malignancy were included in the study.
Results Over 5 years, 13 patients were identified who had erroneous reporting of malignancy
due to NSF reconstruction. On average, two neuroradiologists interpreted the NSF as
persistent or recurrent malignancy over this time period (range: 1–7). The key findings
suspicious for recurrence were enhancement and soft tissue thickening of the NSF.
These findings were present in at least one postoperative scan in all patients.
Conclusion Neuroradiologists and rhinologists performing surveillance on patients with a history
of skull base malignancy with NSF reconstruction should maintain collaborative efforts
to accurately interpret radiologic findings of the NSF during postoperative imaging.
Keywords
nasoseptal flap - endoscopic skull base surgery - cranial base - skull base tumor
- endoscopic resection - endonasal skull base resection - skull base malignancy
