Pedicled Nasoseptal Flap After Endoscopic Endonasal Resection of Skull Base Tumors: A Comparative Meta-Analysis with Other Modalities of Reconstruction

Objectives Endoscopic endonasal surgery for skull base tumors has advanced significantly, but postoperative cerebrospinal fluid (CSF) leak remains a significant concern. Introducing the vascularized pedicled nasoseptal flap (PNSF) has markedly reduced CSF leak rates, though outcomes remain variable across different studies. This systematic review and meta-analysis aimed to compare the efficacy of vascularized versus nonvascularized reconstruction techniques in these procedures. Design Three databases (PubMed, Cochrane, and Embase) were systematically searched to identify studies comparing CSF leak rates between PNSF and nonvascularized techniques for reconstruction after endoscopic endonasal skull base surgeries. It was designed according to the preferred reporting items for systematic reviews and meta-analyses reporting guidelines. Statistical analysis was performed using Review Manager, with heterogeneity evaluated via the I-2 statistic. Results After thorough selection, twenty articles were selected, and a total of 4,088 patients were included, of whom 1,851 were assigned to the nasoseptal flap group, and 2,237 were assigned to the no-flap group. The postoperative CSF leak ratio was significantly lower in the group that underwent reconstruction with PNSF compared with all the other grouped methods, respectively, 3.4 and 5.6% (odds ratio [OR]: 0.48; 95% confidence interval [CI]: 0.34-0.66; p < 0.00001; I-2 = 54%). Conclusion Our results suggest that using the PNSF is associated with a lower incidence of postoperative CSF leak than other reconstruction techniques in endoscopic skull base surgeries and may be used for patients at risk of this complication.