Sphenoid Mucocele: A Complication of Skull Base Reconstruction with Nasoseptal Flap-A Critical Review and Our Experience

Abstract

The evolution of expanded endoscopic skull base surgery has enabled development of minimally invasive approaches for resection of large skull base tumors with the nasoseptal flap proving to be an indispensable tool in skull base reconstruction. We here present our experience of sphenoid mucocele development after skull base reconstruction with the nasoseptal flap along with a comprehensive review of the limited literature on the same. With the expanding scope of endoscopic skull base surgery, the nasoseptal flap is increasingly being used for reconstruction. Despite adherence to standard recommendations and use of meticulous technique during flap placement, the potential risk of mucocele formation under the flap should always be borne in mind. In our experience, displacement of the flap pedicle could lead to ostial obstruction and mucocele formation. Hence, in addition to meticulous technique, a close follow up of such patients via nasal endoscopy or imaging is important to further our knowledge and understanding of the long-term effects and complications of this flap.

Keywords: Complication of nasoseptal flap; Endoscopic skull base surgery; Nasoseptal flap; Sphenoid mucocele.

Fig. 1

Intraoperative view of posterior foveal defect on right. Frontal recess visualized beyond anterior edge of skull base defect

Fig. 2

Intraoperative view depicting positioning of nasoseptal flap over defect

Fig. 3

MRI imaging revealed a well-defined T2 hyperintense cystic lesion in the sphenoid sinus

Fig. 4

Intraoperative visualization of sphenoid mucocele. Obstruction of sphenoid sinus ostium bilaterally caused by the displaced pedicle of the nasoseptal flap (a) and neo-osteogenesis on left as a sequela of FESS surgery (b)

Fig. 5

Intraoperative view after sphenoid mucocele marsipulization. Bony erosion of sella with exposure of dura visualized