Updates in reconstruction of skull base defects

Abstract

Endoscopic resection of previously unapproachable skull base lesions has become possible with advancements in technology, as well as reconstructive methods. These newer techniques may offer improved outcomes and lower morbidity over conventional surgery.

Surgical Management of Giant Cell Tumors in Temporomandibular Joint Region Involving Lateral Skull Base: A Multidisciplinary Approach

“…31 On the one hand, to ensure a watertight dural closure, different techniques have been applied in our study. A postoperative cerebrospinal fluid leak could be prevented with simple interrupted sutures and artificial sealants for small dural tears.…”

The extended nasoseptal flap for coverage of large cranial base defects

“…Historically, the PCF was the reconstruction technique of choice for open approaches, as it has a robust vascular supply and may reach from the posterior table of the frontal sinus to the parasellar region . Although its primary use remains with open approaches, it can be delivered through an incision in the nasion region obviating the need for a craniotomy . Likewise, the TPFF, based on the superficial temporal artery, must be harvested via an open approach and tunneled through the temporal fossa, which has the potential to result in vessel torsion.…”

“…The AITF has been shown to cover defects in the posterior frontal sinus wall and cribriform plate . The MTF is also based on a branch of the sphenopalatine artery and, although it may be used for small anterior defects of the cribriform or fovea ethmoidalis, it yields thin and less abundant mucosa that will not reach superior and lateral margins of the frontal sinus …”

Application of “parachute” technique for free flap reconstruction in advanced tongue cancer after ablation without lip-jaw splitting

“…Pectoralis major myocutaneous (PMMC) flap is still playing a role in head and neck cancer reconstruction. [27,28,29,30] The bulkiness of this flap can increase the difficulty of flap inset. The “reverse upward” parachute technique can also be a good solution once we face this situation in our practice for a mouth floor reconstruction.…”