NSF is the reconstructive workhorse for ESBS. However, there is morbidity associated with its use. The bilateral NSRF technique offers a quicker alternative to upfront NSF harvest yet permits a tailored NSF if needed after the defect has been created. Existing researches have not well-studied utility, and implications of this strategy have.

The researchers retrospectively analyzed one hundred and twenty-five consecutive transsphenoidal cases where they used an NSRF approach at the Cleveland Clinic. They examined records for conversion to NSF, outcomes, and reconstruction-related complications.

NSRF was utilized and converted to formal NSF in 3 patients who had previous remote transsphenoidal surgery. One patient who had an NSRF without a full NSF raised had a postoperative CSF leak; however, the analysis revealed no CSF leaks or flap ischemia for those who had full NSFs raised, even in revision surgery.

The study concluded that the NSRF approach provides the reliability and flexibility of vascularized reconstruction, without the perioperative disadvantages of an upfront NSF harvest. The low and successful conversion rate to NSF demonstrates this strategy’s utility, which should be incorporated into the standard approach for routine transsphenoidal surgery.

Reference: https://journals.sagepub.com/doi/full/10.1177/1945892419892164