Hadad-Bassagasteguy flap in reconstruction of skull base defects after endonasal skull base surgery


  • Chandra Veer Singh BombayHospital aDepartment of Otorhinolaryngology, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtrand Institute of medical science
  • Nishit J. Shah Department of Otorhinolaryngology, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra




Hadad-Bassagasteguy flap, Endonasal flap, Reconstruction of anterior skull base defect, Reconstruction of cerebrospinal fluid leak


Background: To study the clinical outcomes of Hadad-Bassagasteguy flap (HBF) in endonasal reconstruction of anterior skull base defects.

Methods: We prospectively analyzed the demographic data & the outcome results particularly Post-operative CSF leak in 53 patients who underwent HBF in our hospital from February 2013 to June 2014. The early harvested flap was used to reconstruct anterior skull base defects among patients with high-flow on-table CSF leak. Post-operatively the patients were analyzed for CSF leak and bleeding.  

Results: Most of the study subjects were between21-50 years of age (73.6%). The mean age of the study subjects was 41.8±13.8 years. Male/female ratio of the study sample was 1.2 with 29 males and 24 females. Of the total 53 patients 46 (86.8%) has macro defects while 7 (13.2%) had micro defects. Non-secretary lesions were present in 60.4% (32/53) patients while secretary were present in 39.6% (21/53) patients. Cerebrospinal fluid leak was present in all the patients undergoing surgery and majority of them were put on lumbar drain, while bleeding was present in 49.1% patients. Of the total 53 patients only 2 had post-operative cerebrospinal fluid leak (2/53; 3.8%).

Conclusions: Use of HB posterior nasal septal flap for reconstruction of anterior skull base among patients with high-flow intra-operative CSF leak has a remarkable impact in preventing post-operative CSF leak. Its applicability to wide patient-profiles with respect to age, size of defect, diagnosis is making it a versatile choice of reconstruction after endonasal anterior skull base surgeries.


Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope. 2006;116:1882–6.

Kassam A, Thomas A, Carrau R, et al. Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery. 2008;63:52–3.

Stammberger H, Lund VJ. Anatomy of the nose and paranasal sinuses. Scott Brown Otorhinolaryngol Head Neck surgery. 7th edition. 2008;104:1315-43.

Locatelli D, Rampa F, Acchiardi I, Bignami M, De Bernardi F, Castelnuovo P. Endoscopic endonasal approaches for repair of cerebrospinal fluid leaks: nine-year experience. Neurosurgery. 2006;58:246-56.

Hegazy HM, Carrau RL, Snyderman CH, Kassam A, Zweig J. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea: a meta-analysis. Laryngoscope. 2000;110:1166-72.

Schick B, Ibing R, Brors D, Draf W. Long-term study of endonasal duraplasty and review of the literature. Ann Otol Rhinol Laryngol. 2001;110:142-7.

Carrabba G, Dehdashti AR, Gentili F: Surgery for clival lesions: Open resection versus the expanded endoscopic endonasal approach. Neurosurg Focus. 2008;25(6):7.

El-Banhawy OA, El-Dien Ael-H, Zolfakar AS, Halaka AN, Ayad H: Endoscopic endonasal partial middle turbinectomy approach: Adaptability of the procedure in a cadaveric study in surgery for different sphenoid sinus and skull base lesions. Skull Base. 2006;16(1):1-13.

El Banhawy OA, Halaka AN, Altuwaijri MA, Ayad H, El- Sharnoby MM: Long-term outcome of endonasal endoscopic skull base reconstruction with nasal turbinate graft. Skull Base. 2008;18(5):297-308.

Zanation AM, Carrau RL, Snyderman CH, Germanwala AV, Gardner PA, Prevedello DM, Kassam AB. Nasoseptal flap reconstruction of high flow intraoperative cerebral spinal fluid leaks during endoscopic skull base surgery. Am J Rhinol Allergy. 2009;23:518-21.

Eloy JA, Patel AA, Shula PA, Choudhary OJ, Liu JK, Early harvesting of the vascularised pedicled nasoseptal flap during endoscopic skull base surgery. Am J Otolaryngol. 2013;34(3):188-94.

Xuejian W, Fan H, Xiaobiao Z, Yong Y, Ye G, Tao X, et al. Endonasal Endoscopic Skull Base Multilayer Reconstruction Surgery with Nasal Pedicled Mucosal Flap to Manage High Flow CSF Leakage. Turkish Neurosurg. 2013;23(4):439-45.

Brian WR, Samantha S, Neil D. Olfactory Outcomes after Endoscopic Transsphenoidal Pituitary Surgery. Laryngoscope. 2011;121:1611–3.






Original Research Articles