{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T19:38:38Z","timestamp":1740166718088,"version":"3.37.3"},"reference-count":10,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg B Skull Base"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Transpterygoid approaches to the skull base require dissection of the sphenopalatine artery, potentially compromising the option to harvest an ipsilateral nasoseptal flap (NSF) for reconstruction. In cases where other reconstructive options are limited, it may be necessary to utilize a NSF ipsilateral to the transpterygoid approach. Here, we describe the technique of NSF pedicle preservation with reconstruction outcomes.<\/jats:p><jats:p>\n          Methods\u2003This was a retrospective single-institution review of all expanded endonasal skull base cases utilizing a NSF ipsilateral to a transpterygoid approach. Reconstruction outcomes collected include intraoperative fluorescence with indocyanine green (ICG), postoperative magnetic resonance imaging (MRI) gadolinium enhancement, endoscopic assessment, and reconstruction-related complications.<\/jats:p><jats:p>\n          Results\u2003Twenty-one cases were included in this study (mean age 51.0\u2009\u00b1\u200920.6 years, 61.9% female). Indications for NSF ipsilateral to the transpterygoid approach included: bilateral transpterygoid approach (52.4%), revision reconstruction (23.8%), or significant septal deviation (19.0%). Twelve of 14 (85.7%) flaps demonstrated intraoperative perfusion with ICG, 15 of 15 (100%) enhanced on postoperative MRI, and 21 of 21 (100%) flaps had a healthy, viable appearance on postoperative endoscopy. There were no instances of flap necrosis or postoperative cerebrospinal fluid leaks. Technical keys to optimize mobilization of the pedicle include wide decompression of the sphenopalatine foramen and release of neurovascular tethering points of the pterygopalatine fossa. These steps allow for wide skull base exposure with preservation of the sphenopalatine artery.<\/jats:p><jats:p>\n          Conclusion\u2003With this technique, the transpterygoid approach can be performed in a manner that preserves the pedicle for an ipsilateral NSF and achieve an excellent reconstructive outcome.<\/jats:p>","DOI":"10.1055\/s-0043-1778662","type":"journal-article","created":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T00:11:10Z","timestamp":1705968670000},"page":"076-081","source":"Crossref","is-referenced-by-count":0,"title":["Ipsilateral Nasoseptal Flaps in a Transpterygoid Approach: Technical Pearls and Reconstruction Outcomes"],"prefix":"10.1055","volume":"86","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9519-5880","authenticated-orcid":false,"given":"Michael T.","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Grimm","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2084-4863","authenticated-orcid":false,"given":"Karam","family":"Asmaro","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States"},{"name":"Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Yong","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Low","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine K.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jayakar V.","family":"Nayak","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter H.","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan C.","family":"Fernandez-Miranda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2072-982X","authenticated-orcid":false,"given":"Zara M.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,1,22]]},"reference":[{"issue":"119","key":"ref1","first-page":"361","article-title":"Ipsilateral nasoseptal flap pedicle for transpterygoid approach: technical note","volume":"33","author":"P Anania","year":"2021","journal-title":"Iran J Otorhinolaryngol"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.anorl.2019.10.006","article-title":"Anatomo-radiological study supporting the use of ipsilateral nasoseptal flap for the transpterygoid management of temporo-sphenoidal meningoceles. A review of 21 cases","volume":"137","author":"S Bartier","year":"2020","journal-title":"Eur Ann Otorhinolaryngol Head Neck Dis"},{"issue":"10","key":"ref3","doi-asserted-by":"crossref","first-page":"2224","DOI":"10.1002\/lary.29672","article-title":"Modified transpterygoid approach to sphenoid meningoencephaloceles: a shorter run for a longer slide","volume":"131","author":"S B Sreenath","year":"2021","journal-title":"Laryngoscope"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1002\/lary.24256","article-title":"Extended dissection of the septal flap pedicle for ipsilateral endoscopic transpterygoid approaches","volume":"124","author":"C D Pinheiro-Neto","year":"2014","journal-title":"Laryngoscope"},{"issue":"05","key":"ref5","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1055\/s-0037-1602777","article-title":"Indocyanine green fluorescence to evaluate nasoseptal flap viability in endoscopic endonasal cranial base surgery","volume":"78","author":"E E Kerr","year":"2017","journal-title":"J Neurol Surg B Skull Base"},{"issue":"10","key":"ref7","doi-asserted-by":"crossref","first-page":"1882","DOI":"10.1097\/01.mlg.0000234933.37779.e4","article-title":"A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap","volume":"116","author":"G Hadad","year":"2006","journal-title":"Laryngoscope"},{"issue":"05","key":"ref8","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1002\/lary.21419","article-title":"Nasoseptal \u201crescue\u201d flap: a novel modification of the nasoseptal flap technique for pituitary surgery","volume":"121","author":"C M Rivera-Serrano","year":"2011","journal-title":"Laryngoscope"},{"issue":"06","key":"ref9","doi-asserted-by":"crossref","first-page":"E5","DOI":"10.3171\/2012.3.FOCUS1267","article-title":"Surgical nuances for the endoscopic endonasal transpterygoid approach to lateral sphenoid sinus encephaloceles","volume":"32","author":"R F Schmidt","year":"2012","journal-title":"Neurosurg Focus"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"e473","DOI":"10.1016\/j.wneu.2018.06.219","article-title":"Surgical management of sphenoid sinus lateral recess cerebrospinal fluid leaks: a single neurosurgical center analysis of endoscopic endonasal minimal transpterygoid approach","volume":"118","author":"M O Ulu","year":"2018","journal-title":"World Neurosurg"},{"issue":"04","key":"ref11","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1007\/s12070-019-01715-w","article-title":"Contrasting surgical management of CSF leak from lateral recess of sphenoid sinus and its surgical outcomes: our experience","volume":"71","author":"A R Babu","year":"2019","journal-title":"Indian J Otolaryngol Head Neck Surg"}],"container-title":["Journal of Neurological Surgery Part B: Skull Base"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0043-1778662.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T00:21:00Z","timestamp":1738110060000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0043-1778662"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,22]]},"references-count":10,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2025,1,28]]},"published-print":{"date-parts":[[2025,2]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0043-1778662","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2193-6331","2193-634X"],"issn-type":[{"type":"print","value":"2193-6331"},{"type":"electronic","value":"2193-634X"}],"subject":[],"published":{"date-parts":[[2024,1,22]]}}}