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Single Versus Double Hadad-Bassagasteguy Flap in Expanded Endoscopic Skull-Base Surgery

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Abstract

The reconstruction of dural defects, after endoscopic removal of skull-base lesions, remains challenging when a large defect or a high flow intraoperative cerebrospinal fluid (CSF) leak is observed. The aim of this study is to describe our preliminary experience with a double Hadad-Bassagasteguy (H-B) flap technique for skull-base repair, comparing its efficacy with the use of a single H-B flap in our series. A retrospective chart review was conducted on patients who underwent exclusive endoscopic endonasal skull-base surgery at our Referral Skull Base Center from December 2014 to January 2018. Data on patient demographics, pathology, preoperative and postoperative imaging, intraoperative findings, surgical route, defect size, reconstruction techniques and repair materials, were analyzed. Patients were divided into double and single H-B flap groups. In the single and double H-B groups, the postoperative CSF leak rates were 37.5% (6 of 16 patients) and 4.5% (1 of 22 patients), respectively. The difference between the two groups was statistically significant (p = 0.0470). In patients with defects > 4 cm or high-flow intraoperative CSF leakage related to the opening of the third ventricle, the double H-B flap was successfully placed with no occurrence of postoperative CSF leakage. The double H-B flap significantly reduced the postoperative CSF leakage rate after expanded transnasal skull-base surgery. Particularly in challenging cases, where a large skull-base defect or a high-flow intraoperative CSF leak was observed, this reconstructive method proved to be very effective, with no evidence of postoperative CSF fistulas.

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Funding

The authors did not receive any grant for this study from funding agencies in the public, commercial or not-for profit sectors.

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Authors and Affiliations

  1. Otolaryngology Department, Verona University Hospital, Verona, Italy

    Molteni Gabriele, Gulino Antonio, Caiazza Nicole & Marchioni Daniele

  2. Neurosurgery Department, Verona University Hospital, Verona, Italy

    Musumeci Angelo

Authors
  1. Molteni Gabriele
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  2. Gulino Antonio
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  3. Caiazza Nicole
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  4. Musumeci Angelo
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  5. Marchioni Daniele
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Correspondence to Caiazza Nicole.

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The authors declare that the study was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration. All the authors have read and approved the manuscript.

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Gabriele, M., Antonio, G., Nicole, C. et al. Single Versus Double Hadad-Bassagasteguy Flap in Expanded Endoscopic Skull-Base Surgery. Indian J Otolaryngol Head Neck Surg 74, 394–401 (2022). https://doi.org/10.1007/s12070-021-02961-7

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  • DOI: https://doi.org/10.1007/s12070-021-02961-7

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