{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:54:13Z","timestamp":1786125253241,"version":"build-2736575974"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2018,4,24]],"date-time":"2018-04-24T00:00:00Z","timestamp":1524528000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>The nasoseptal flap is the main pedicled flap used for endoscopic cranial base reconstruction. For large anterior cranial base defects, the anterior edge is a concern for the nasoseptal flap reach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To present a surgical technique that completely releases the vascular pedicle of the nasoseptal flap from the sphenopalatine artery (SPA) foramen improving considerably the reach of the flap.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A patient with left anterior cranial base fracture involving the posterior table of the frontal sinus, who presented with cerebrospinal fluid leak and contused brain herniation to the ethmoid and frontal sinuses. Unilateral endoscopic endonasal anterior cranial base reconstruction was performed with left sided nasoseptal flap. The nasoseptal flap pedicle was dissected and completely released from the SPA foramen. The flap was left attached only to the internal maxillary artery (IMAX) vascular bundle.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The flap covered the entire left anterior cranial base, from the planum sphenoidale to the posterior table of the frontal sinus. There was complete obliteration of the cerebrospinal fluid fistula postoperatively with resolution of the radiographic pneumocephalus and the patient's rhinorrhea.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>The complete release of the nasoseptal flap pedicle from the SPA foramen is feasible and remarkably improves the reach of the flap. It also increases the reconstructive area of the flap since the entire septal mucosa can be used for reconstruction and the pedicle length is based exclusively upon the SPA\/IMAX.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ons\/opy075","type":"journal-article","created":{"date-parts":[[2018,4,24]],"date-time":"2018-04-24T03:14:39Z","timestamp":1524539679000},"page":"37-44","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":15,"title":["Extrapolating the Limits of the Nasoseptal Flap With Pedicle Dissection to the Internal Maxillary Artery"],"prefix":"10.1227","volume":"16","author":[{"given":"Carlos D","family":"Pinheiro-Neto","sequence":"first","affiliation":[{"name":"Division of Otolaryngology and Head-Neck Surgery, Department of Surgery, Albany Medical Center, Albany,\u00a0New\u00a0York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Peris-Celda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler","family":"Kenning","sequence":"additional","affiliation":[{"name":"Depart-ment of Neurosurgery, Albany Medical Center, Albany, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,1]]},"reference":[{"issue":"10","key":"bib1-20240909","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":"Hadad","year":"2006","journal-title":"Laryngoscope"},{"issue":"9","key":"bib2-20240909","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1097\/MLG.0b013e31806db514","article-title":"Improving the design of the pedicled nasoseptal flap for skull base reconstruction: a radioanatomic study","volume":"117","author":"Pinheiro-Neto","year":"2007","journal-title":"Laryngoscope"},{"issue":"12","key":"bib3-20240909","doi-asserted-by":"crossref","first-page":"2514","DOI":"10.1002\/lary.22353","article-title":"Study of the nasoseptal flap for endoscopic anterior cranial base reconstruction","volume":"121","author":"Pinheiro-Neto","year":"2011","journal-title":"Laryngoscope"},{"key":"bib4-20240909","article-title":"The radioanatomy of endonasal flap coverage of skull base defects: a tool for preoperative planning","author":"MacArthur","year":"2017","journal-title":"Laryngoscope"},{"issue":"06","key":"bib5-20240909","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1055\/s-0033-1347368","article-title":"The extended nasoseptal flap for skull base reconstruction of the clival region: an anatomical and radiological study","volume":"74","author":"Peris-Celda","year":"2013","journal-title":"J Neurol Surg B"},{"issue":"1","key":"bib6-20240909","first-page":"42","article-title":"Nasoseptal flap","volume":"74","author":"Pinheiro-Neto","year":"2013","journal-title":"Adv Otorhinolaryngol"},{"issue":"05","key":"bib7-20240909","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1055\/s-0033-1347367","article-title":"Transposition of the pterygopalatine fossa during endoscopic endonasal transpterygoid approaches","volume":"74","author":"Pinheiro-Neto","year":"2013","journal-title":"J Neurol Surg B"},{"issue":"1","key":"bib8-20240909","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1002\/lary.21808","article-title":"Endoscopic anatomy of the palatovaginal canal (palatosphenoidal canal)","volume":"122","author":"Pinheiro-Neto","year":"2012","journal-title":"Laryngoscope"},{"issue":"5","key":"bib9-20240909","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1097\/PRS.0b013e3182a4c37b","article-title":"Cadaveric study of the posterior pedicle nasoseptal flap","volume":"132","author":"Rivera-Serrano","year":"2013","journal-title":"Plast Reconstr Surg"},{"issue":"9","key":"bib10-20240909","doi-asserted-by":"crossref","first-page":"E2495","DOI":"10.1002\/hed.24483","article-title":"Nasoseptal flap for reconstruction after robotic radical tonsillectomy","volume":"38","author":"Pinheiro-Neto","year":"2016","journal-title":"Head Neck"},{"issue":"44","key":"bib11-20240909","doi-asserted-by":"crossref","first-page":"8527","DOI":"10.1097\/MD.0000000000008527","article-title":"Nasoseptal flap reconstruction after oropharyngeal cancer resection","volume":"96","author":"Lee","year":"2017","journal-title":"Medicine"},{"issue":"06","key":"bib12-20240909","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1055\/s-0030-1253573","article-title":"How to choose? 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