Evolution of Radiographic Changes of a Vascularized Pedicled Nasoseptal Flap after Endonasal Endoscopic Skull Base Surgery

A, Immediate postoperative imaging following resection of an endoscopic transsellar pituitary adenoma with an intraoperative CSF leak demonstrates full coverage of sellar defect with the NSF in the shape of a C. There is elevation of the diaphragma sellae and compression of the pituitary gland. The flap pedicle and body are both brightly enhancing, with complete adherence to the skull base. B, Delayed imaging demonstrates continued enhancement of the flap with complete adherence to the skull base, as well as re-expansion of the pituitary gland and collapse of the diaphragma sellae.

A, Immediate postoperative imaging following resection of an endoscopic transsellar pituitary adenoma with an intraoperative CSF leak shows full coverage of sellar defect, demonstrating that the enhancing nasoseptal flap appears to be nonadherent to the skull base. B, Delayed imaging confirms that the flap is now uniformly opposed to the skull base.