gms | German Medical Science

Introduction: Among patients who undergo reconstruction of skullbase defects using vascularized pedicled nasoseptal flap following endoscopic skull base surgery,

1.

To assess the postoperative MR imaging appearance of vascularized pedicled nasoseptal flap for its viability and failure.

2.

To determine the variations in MRI that may suggest potential flap failure.

Materials and Methods: A prospective study of 13 patients who underwent endoscopic skull base surgery for resection of sellar lesions with skull base reconstruction by multilayered reconstruction including the Hadad-Bassagasteguy flap. All patients had preoperative, and delayed postoperative MR imaging scans. Flap features that were evaluated included flap configuration, signal intensity characteristics on T1-weighted and T2-weighted images, enhancement patterns, location, and flap thickness.

Results: All patients had detectable postoperative skull base defects. All patients had C-shaped configuration flaps within the operative defect, which were isointense on T1-weighted and T2-weighted images on both immediate and delayed postoperative MR imaging scans. On the immediate scans, 12 of 13 patients had enhancing flaps and one had minimal to no enhancement. To the best of our knowledge, this is the first prospective study of assessment of viability of vascularized nasoseptal flap using post-operative MRI.

Conclusion: Vascular pedicle nasoseptal(Hadad) flaps have a characteristic MR imaging appearance. It is important to recognize this appearance and to evaluate for variations that may suggest potential flap failure.

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