Pedicled nasoseptal flap reconstruction for craniopharyngiomas in pediatric patients

  • Anya Laibangyang
  • Shaun D. RodgersEmail author
  • Shanna L. Baron
  • B. Todd Schaeffer
  • Mark Shikowitz
  • Mark A. Mittler
  • Steven J. Schneider
Focus Session



Though the use of the pedicled nasoseptal flap (NSF), a reconstructive technique used after endoscopic endonasal approaches (EEA) for resection of craniopharyngiomas, has been shown to reduce the occurrence of post-operative cerebrospinal fluid (CSF) leaks in adults, less is known about its use in pediatric populations, specifically in children under the age of 7. The goal of this retrospective cohort study is to determine the viability of the pedicled NSF for pediatric patients.


Retrospective review of 12 pediatric patients (ages 2–16) undergoing 13 NSF reconstructions after resection of craniopharyngiomas. Radioanatomic analysis of computed tomography (CT) scans was utilized to classify the pneumatization of the sphenoid sinus depending on the thickness of the sphenoid bone margin. Intercarotid distances were measured from magnetic resonance imaging (MRI) scans to assess the feasibility of this reconstruction technique in pediatric patients.


At the time of surgery, all patients were noted to have adequate NSF length and width. No post-operative high-flow CSF leaks were found within the group. Lack of pneumatization of the sphenoid sinus and narrow intercarotid distances in the youngest of patients did not lead to negative clinical outcomes.


Based on our results and experience, the pedicled nasoseptal flap is a viable reconstructive option after EEA in the pediatric population, including even the youngest of patients. In these patients, a narrowed window between the intercarotid arteries and the lack of pneumatization of the sphenoid sinus present a challenge that can be overcome by using stereotactic navigation and advanced endoscopic techniques.


Pediatric neurosurgery Nasoseptal flap Craniopharyngioma Reconstruction 


Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study for the findings specified in this paper.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadUSA
  2. 2.Division of Pediatric NeurosurgeryCohen Children’s Medical CenterNew Hyde ParkUSA
  3. 3.Department of OtolaryngologyLong Island Jewish Medical CenterQueensUSA

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