Objectives Our objective was to determine if decreased contrast enhancement on postoperative magnetic resonance imaging (MRI) is associated with an increased risk of complication in patients who have undergone nasoseptal flap (NSF) reconstruction.

Design/Setting This was a single-institution retrospective study of patients who underwent a first-time endoscopic endonasal approach (EEA) with NSF reconstruction.

Participants Patients underwent an EEA to the skull base with NSF reconstruction and received postoperative MRI within 3 weeks of the operation.

Main Outcome Measures MR exams were scored on the degree of contrast enhancement at first postoperative MRI. An enhancement score of 4 indicated ≥75% enhancement of the NSF. A score of 3 indicated enhancement ≥50% and <75% enhancement of the NSF. A score of 2 indicated ≥25% and <50% enhancement of the NSF. Complications (e.g., cerebrospinal fluid [CSF] leak, meningitis, empyema, cerebritis, brain abscess, flap necrosis, and flap migration) were retrieved from our institution's skull base database. Logistic regression was used to determine the effect of the MRI enhancement score on the odds of developing a complication.

Results Out of 99 patients in the study, six had complications. Patients who underwent NSF reconstruction of skull base defects were found to have 19 times higher odds of complication (p = 0.007) if they had had an NSF enhancement score of 2 on their postoperative MRI when compared with patients with complete or near complete NSF enhancement (score 4).

Conclusions Quantifying NSF enhancement with an MRI may help surgeons better predict which of their patients are at an increased risk of complication.

目的 我们的目的是确定术后磁共振成像 (MRI) 对比度增强的降低是否与接受鼻中隔皮瓣 (NSF) 重建的患者并发症风险增加相关。

设计/背景 这是一项单机构回顾性研究，对象是首次接受 NSF 重建内镜鼻内入路 (EEA) 的患者。

参与者 患者接受了 NSF 重建颅底 EEA 治疗，并在手术后 3 周内接受了术后 MRI 检查。

主要结果指标 MR 检查根据术后第一次 MRI 的对比增强程度进行评分。增强分数 4 表示 NSF 增强≥75%。3 分表示 NSF 增强≥50% 且<75%。2 分表示 NSF 增强≥25% 且<50%。从我们机构的颅底数据库中检索并发症（例如脑脊液 [CSF] 漏、脑膜炎、脓胸、脑炎、脑脓肿、皮瓣坏死和皮瓣移位）。使用逻辑回归来确定 MRI 增强评分对发生并发症的几率的影响。

结果 在该研究的 99 名患者中，有 6 名出现并发症。 研究发现，与完全或接近完全 NSF 增强的患者相比，如果术后 MRI 的 NSF 增强评分为 2，接受 NSF颅底缺损重建的患者出现并发症的几率要高出 19 倍（p = 0.007）。得分 4）。

结论 通过 MRI 量化 NSF 增强可能有助于外科医生更好地预测哪些患者出现并发症的风险增加。