METHODS: We retrospectively reviewed 10 patients who underwent EENS for resection of sellar lesions with skull base reconstruction by multilayered reconstruction including the Hadad-Bassagasteguy flap. All patients had preoperative, immediate, and delayed postoperative MR imaging scans. Flap features that were evaluated included flap configuration, signal intensity characteristics on T1-weighted and T2-weighted images, enhancement patterns, location, and flap thickness.
RESULTS: All patients had detectable postoperative skull base defects. All patients had C-shaped configuration flaps within the operative defect, which were isointense on T1-weighted and T2-weighted images on both immediate and delayed postoperative MR imaging scans. On the immediate scans, 8 of 10 patients had enhancing flaps and 2 of 10 had minimal to no enhancement. There were 9 of 10 patients who had enhancing flaps on delayed scans, and 2 of 10 patients had flaps that increased in enhancing coverage on the delayed scans.
CONCLUSIONS: Vascular pedicle nasoseptal flaps have a characteristic MR imaging appearance. It is important for the radiologist to recognize this appearance and to evaluate for variations that may suggest potential flap failure.