Delayed-onset cavernous sinus dural arteriovenous fistula after nasoseptal flap reconstruction: illustrative case

Pedicled nasoseptal flap (NSF) is the gold-standard skull base reconstruction method in endoscopic endonasal surgery (EES). Although vascular complications, such as internal carotid artery injury or carotid-cavernous fistula (CCF), are well documented, dural arteriovenous fistula (dAVF) originating from the vascular network of an NSF is exceedingly rare....

No change to routine audiological practice; however, audiologists should be aware that delayed vascular complications (including pulsatile tinnitus) may follow skull base surgery involving nasoseptal flap reconstruction.

This case expands awareness of rare but serious delayed neurovascular complications after increasingly common endoscopic skull base procedures, with potential auditory and vestibular presentations relevant to audiologists.

1. 01Case report describes a delayed-onset cavernous sinus dural arteriovenous fistula (abnormal artery-vein connection) after nasoseptal flap skull base surgery.
2. 02Delayed presentation means the complication may not be immediately attributed to the prior surgical procedure.
3. 03Symptoms of dural arteriovenous fistulas can include pulsatile tinnitus, eye signs, and hearing changes — all within the audiologist's scope of recognition.
4. 04Case published in the Journal of Neurosurgery: Case Lessons (CASE); evidence limited to a single patient.
5. 05Highlights need for long-term follow-up and vigilance in patients with history of skull base endoscopic surgery.

PMID

42224732

DOI

10.3171/CASE26300.

Journal

Journal of Neurosurgery: CASE

Publication type

case_report

Evidence level

4

Sample size

1

Population

Single patient who developed a delayed cavernous sinus dural arteriovenous fistula following nasoseptal flap reconstruction in endoscopic endonasal skull base surgery

Intervention

Nasoseptal flap reconstruction in endoscopic endonasal skull base surgery