Radioanatomical Study of the Skull Base and Septum in Chinese: Implications for Using the HBF for Endoscopic Skull Base Reconstruction

OBJECTIVE: Radioanatomy provides surgeons with different choices to prevent the failure of reconstruction caused by improper flap selection and the occurrence of CSF leakage or other severe complications. To establish a radioanatomical model, this study radioanatomically investigated the use of the Hadad–Bassagasteguy nasoseptal flap (HBF) in skull base reconstruction performed via the transethmoidal, transsphenoidal, and transclival approaches to provide preoperative guidance for the selection of approaches for skull base reconstruction and preparation of the HBF. METHODS: The computed tomography images of 40 Chinese adults were selected for the radioanatomical measurement of data related to the HBF and skull base reconstruction via the transethmoidal, transsphenoidal, and transclival approaches. The results were analyzed using radioanatomy combined with SPSS-based analysis. RESULTS: In the 40 patients, the area of the HBF exceeded that of skull base defects reconstructed via the transethmoidal approach by 10.21 ± 1.97 cm(2), and the anterior margin width, posterior margin width, upper margin length, and lower margin lengths of the HBF all exceeded the corresponding values of skull base defects requiring reconstruction by at least 8.4 mm. The area of the HBF exceeded that of reconstructed skull base defects by an average of 10.72 ± 2.04 cm(2). The area of the HBF exceeded that of skull base defects reconstructed via the transclival approach by 9.01 ± 2.87 cm(2). The difference between the anterior margin width of the HBF and the middle width of skull base defects reconstructed via the transclival approach did not exceed 6 mm in only one case (5.4 mm). CONCLUSION: In Chinese adults, the HBF can cover skull base defects reconstructed via the transethmoidal, transsphenoidal, and transclival approaches, permitting its use in skull base reconstruction performed via all three approaches. Radioanatomy can be used for preoperative guidance to plan surgery via the transethmoidal, transsphenoidal, and transclival approaches.