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 VIDEO SECTION: STEP BY STEP: OPERATIVE NUANCES
Year : 2021  |  Volume : 69  |  Issue : 2  |  Page : 307--310

Bilateral Posterior Nasoseptal Flap – Double Breasting Technique


1 Department of Neurosurgery, M S Ramaiah Memorial Hospital, Bangalore, Karnataka, India
2 Department of Ear Nose and Throat, M S Ramaiah Medical College and Hospital, Bangalore, Karnataka, India

Correspondence Address:
Rakshith Srinivasa
Department of Neurosurgery, MS Ramaiah Medical College and Hospital, Bangalore - 560 054, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.314538

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Background and Introduction: The success of endoscopic skull base surgery is largely based on the effective repair of the skull base defect. A pedicled nasoseptal flap (NSF), described by Hadad-Bassagateguy is the workhorse of contemporary endoscopic skull base repair. We describe a modification in the technique, “double breasting technique,” using the bilateral posterior NSF for skull base repair. Objective: In this video article, we describe the technique of harvesting bilateral posterior nasal septal flaps and overlaying the flaps in a double breasting technique to cover the skull base defect. The posterior NSF can be used to cover medium to large skull base defects effectively. Surgical Technique: A 40-year-old female patient presented with headache and decreased vision for 2 months. MRI with gadolinium showed a sellar suprasellar lesion with chiasmal compression. Visual field charting showed bitemporal hemianopia. She underwent endoscopic transnasal transsphenoidal surgery (binostril approach) and complete excision of tumor. Intraoperatively, there was evidence of arachnoid breach with high flow cerebrospinal fluid (CSF) leak. Sella was repaired with fat, fascia, fibrin glue, and overlaid with the bilateral posterior NSF in a double breasting technique, as described in the video. Results: The skull base repair was successful, with no CSF leak postoperatively.






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