Janus flap: bilateral nasoseptal flaps for anterior skull base reconstruction. 2010

Gurston G Nyquist, and Vijay K Anand, and Ameet Singh, and Theodore H Schwartz
Department of Otorhinolaryngology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA. ggnyquist@hotmail.com

OBJECTIVE Large dural defects after extended endoscopic endonasal skull base resections require meticulous reconstruction to prevent a cerebrospinal fluid leak postoperatively. The nasoseptal flap is a vascularized tissue graft developed to aid in the multilayer reconstruction of the skull base. The purpose of this study is to describe the first experiences with bilateral nasoseptal flaps for reconstruction of very large skull base defects. METHODS Prospective, observational study. METHODS Large tertiary referral center (New York Presbyterian Hospital). METHODS Five patients underwent a multilayer reconstruction after an extended endoscopic transsphenoidal skull base surgery that included bilateral nasoseptal flaps. Pathologies consisted of two pituitary macroadenomas, one planum sphenoidale meningioma, one craniopharyngioma, and one cavernous sinus hemangioma. RESULTS All five patients underwent successful skull base reconstruction without a cerebrospinal fluid leak, complication at the reconstruction site, or anterior extension of the posterior septal perforation. CONCLUSIONS Bilateral nasoseptal flaps are a viable option for large dural defects of the anterior and ventral skull base when one nasoseptal flap may not completely seal the entire defect.

UI MeSH Term Description Entries
D008297 Male Males
D008579 Meningioma A relatively common neoplasm of the CENTRAL NERVOUS SYSTEM that arises from arachnoidal cells. The majority are well differentiated vascular tumors which grow slowly and have a low potential to be invasive, although malignant subtypes occur. Meningiomas have a predilection to arise from the parasagittal region, cerebral convexity, sphenoidal ridge, olfactory groove, and SPINAL CANAL. (From DeVita et al., Cancer: Principles and Practice of Oncology, 5th ed, pp2056-7) Benign Meningioma,Malignant Meningioma,Meningiomas, Multiple,Meningiomatosis,Angioblastic Meningioma,Angiomatous Meningioma,Cerebral Convexity Meningioma,Clear Cell Meningioma,Fibrous Meningioma,Hemangioblastic Meningioma,Hemangiopericytic Meningioma,Intracranial Meningioma,Intraorbital Meningioma,Intraventricular Meningioma,Meningotheliomatous Meningioma,Microcystic Meningioma,Olfactory Groove Meningioma,Papillary Meningioma,Parasagittal Meningioma,Posterior Fossa Meningioma,Psammomatous Meningioma,Secretory Meningioma,Sphenoid Wing Meningioma,Spinal Meningioma,Transitional Meningioma,Xanthomatous Meningioma,Angioblastic Meningiomas,Angiomatous Meningiomas,Benign Meningiomas,Cerebral Convexity Meningiomas,Clear Cell Meningiomas,Convexity Meningioma, Cerebral,Convexity Meningiomas, Cerebral,Fibrous Meningiomas,Groove Meningiomas, Olfactory,Hemangioblastic Meningiomas,Hemangiopericytic Meningiomas,Intracranial Meningiomas,Intraorbital Meningiomas,Intraventricular Meningiomas,Malignant Meningiomas,Meningioma, Angioblastic,Meningioma, Angiomatous,Meningioma, Benign,Meningioma, Cerebral Convexity,Meningioma, Clear Cell,Meningioma, Fibrous,Meningioma, Hemangioblastic,Meningioma, Hemangiopericytic,Meningioma, Intracranial,Meningioma, Intraorbital,Meningioma, Intraventricular,Meningioma, Malignant,Meningioma, Meningotheliomatous,Meningioma, Microcystic,Meningioma, Multiple,Meningioma, Olfactory Groove,Meningioma, Papillary,Meningioma, Parasagittal,Meningioma, Posterior Fossa,Meningioma, Psammomatous,Meningioma, Secretory,Meningioma, Sphenoid Wing,Meningioma, Spinal,Meningioma, Transitional,Meningioma, Xanthomatous,Meningiomas,Meningiomas, Angioblastic,Meningiomas, Angiomatous,Meningiomas, Benign,Meningiomas, Cerebral Convexity,Meningiomas, Clear Cell,Meningiomas, Fibrous,Meningiomas, Hemangioblastic,Meningiomas, Hemangiopericytic,Meningiomas, Intracranial,Meningiomas, Intraorbital,Meningiomas, Intraventricular,Meningiomas, Malignant,Meningiomas, Meningotheliomatous,Meningiomas, Microcystic,Meningiomas, Olfactory Groove,Meningiomas, Papillary,Meningiomas, Parasagittal,Meningiomas, Posterior Fossa,Meningiomas, Psammomatous,Meningiomas, Secretory,Meningiomas, Sphenoid Wing,Meningiomas, Spinal,Meningiomas, Transitional,Meningiomas, Xanthomatous,Meningiomatoses,Meningotheliomatous Meningiomas,Microcystic Meningiomas,Multiple Meningioma,Multiple Meningiomas,Olfactory Groove Meningiomas,Papillary Meningiomas,Parasagittal Meningiomas,Posterior Fossa Meningiomas,Psammomatous Meningiomas,Secretory Meningiomas,Sphenoid Wing Meningiomas,Spinal Meningiomas,Transitional Meningiomas,Wing Meningioma, Sphenoid,Wing Meningiomas, Sphenoid,Xanthomatous Meningiomas
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009296 Nasal Cavity The proximal portion of the respiratory passages on either side of the NASAL SEPTUM. Nasal cavities, extending from the nares to the NASOPHARYNX, are lined with ciliated NASAL MUCOSA. Nasal Cavities,Cavities, Nasal,Cavity, Nasal
D010911 Pituitary Neoplasms Neoplasms which arise from or metastasize to the PITUITARY GLAND. The majority of pituitary neoplasms are adenomas, which are divided into non-secreting and secreting forms. Hormone producing forms are further classified by the type of hormone they secrete. Pituitary adenomas may also be characterized by their staining properties (see ADENOMA, BASOPHIL; ADENOMA, ACIDOPHIL; and ADENOMA, CHROMOPHOBE). Pituitary tumors may compress adjacent structures, including the HYPOTHALAMUS, several CRANIAL NERVES, and the OPTIC CHIASM. Chiasmal compression may result in bitemporal HEMIANOPSIA. Pituitary Cancer,Cancer of Pituitary,Cancer of the Pituitary,Pituitary Adenoma,Pituitary Carcinoma,Pituitary Tumors,Adenoma, Pituitary,Adenomas, Pituitary,Cancer, Pituitary,Cancers, Pituitary,Carcinoma, Pituitary,Carcinomas, Pituitary,Neoplasm, Pituitary,Neoplasms, Pituitary,Pituitary Adenomas,Pituitary Cancers,Pituitary Carcinomas,Pituitary Neoplasm,Pituitary Tumor,Tumor, Pituitary,Tumors, Pituitary
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D002426 Cavernous Sinus An irregularly shaped venous space in the dura mater at either side of the sphenoid bone. Sinus, Cavernous
D002558 Cerebrospinal Fluid Otorrhea Discharge of cerebrospinal fluid through the external auditory meatus or through the eustachian tube into the nasopharynx. This is usually associated with CRANIOCEREBRAL TRAUMA (e.g., SKULL FRACTURE involving the TEMPORAL BONE;), NEUROSURGICAL PROCEDURES; or other conditions, but may rarely occur spontaneously. (From Am J Otol 1995 Nov;16(6):765-71) Cerebrospinal Otorrhea,Cerebrospinal Fluid Otorrhea, Post-Traumatic,Cerebrospinal Fluid Otorrhea, Spontaneous,Cerebrospinal Fluid Otorrhea, Traumatic,Otorrhea, Cerebrospinal Fluid, Post-Traumatic,Otorrhea, Cerebrospinal Fluid, Spontaneous,Otorrhea, Cerebrospinal Fluid, Traumatic,Otorrhea, Post-Traumatic, Cerebrospinal Fluid,Otorrhea, Spontaneous, Cerebrospinal Fluid,Otorrhea, Traumatic Cerebrospinal Fluid,Post-Traumatic Cerebrospinal Fluid Otorrhea,Post-Traumatic Otorrhea, Cerebrospinal Fluid,Spontaneous Cerebrospinal Fluid Otorrhea,Spontaneous Otorrhea, Cerebrospinal Fluid,Traumatic Cerebrospinal Fluid Otorrhea,Traumatic Otorrhea, Cerebrospinal Fluid,Cerebrospinal Fluid Otorrhea, Post Traumatic,Cerebrospinal Fluid Otorrheas,Otorrhea, Cerebrospinal,Otorrhea, Cerebrospinal Fluid,Post Traumatic Cerebrospinal Fluid Otorrhea,Post Traumatic Otorrhea, Cerebrospinal Fluid
D003397 Craniopharyngioma A benign pituitary-region neoplasm that originates from Rathke's pouch. The two major histologic and clinical subtypes are adamantinous (or classical) craniopharyngioma and papillary craniopharyngioma. The adamantinous form presents in children and adolescents as an expanding cystic lesion in the pituitary region. The cystic cavity is filled with a black viscous substance and histologically the tumor is composed of adamantinomatous epithelium and areas of calcification and necrosis. Papillary craniopharyngiomas occur in adults, and histologically feature a squamous epithelium with papillations. (From Joynt, Clinical Neurology, 1998, Ch14, p50) Craniopharyngioma, Adamantinous,Craniopharyngioma, Papillary,Rathke Pouch Tumor,Craniopharyngioma, Adult,Craniopharyngioma, Child,Neoplasm, Rathke Cleft,Neoplasm, Rathke's Cleft,Rathke Cleft Neoplasm,Rathke's Cleft Neoplasm,Rathke's Pouch Tumor,Adamantinous Craniopharyngioma,Adamantinous Craniopharyngiomas,Adult Craniopharyngioma,Adult Craniopharyngiomas,Child Craniopharyngioma,Child Craniopharyngiomas,Craniopharyngiomas,Craniopharyngiomas, Adamantinous,Craniopharyngiomas, Adult,Craniopharyngiomas, Child,Craniopharyngiomas, Papillary,Neoplasm, Rathkes Cleft,Papillary Craniopharyngioma,Papillary Craniopharyngiomas,Rathkes Cleft Neoplasm,Rathkes Pouch Tumor,Tumor, Rathke Pouch,Tumor, Rathke's Pouch

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