Anterior and Anterolateral Resection for Skull Base Malignancies

Marcus, Joshua; Laufer, Ilya; Mehrara, Babak J.; Kraus, Dennis H.; Singh, Bhuvanesh; Bilsky, Mark H.

doi:10.1016/j.nec.2012.08.008

Cited by 6 publications

(12 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Placement of lumbar drains is controversial, some authors stating that PNC can be worsened by lumbar drains as a consequence of intracranial negative pressure [15,[18][19][20]. Different authors recommend the use of lumbar drains for a maximum of three days and with caution, encouraging passive gravity-dependent drainage, a low flow rate of a maximum 5 mL/hour or epidural drains connected to JP bulb suction [1,15,21,22]. In our study, lumbar drains were routinely placed as part of CSF leak treatment protocol and we were not able to quantify the association with worsening PNC.…”

Section: Discussionmentioning

confidence: 99%

“…There is no consensus regarding pneumocephalus treatment, possibly due to the variate etiologies; however, certain conservative approaches are generally accepted, namely bed rest, oxygen therapy, lumbar drainage, airtight nasal packing and maintaining the patient in the Trendelenburg position. In case medical measures are insufficient, surgical temporizing options for decompression include needle aspiration, burr holes, ventriculostomy and craniotomy [2,4,21]. A more unconventional method proposed by certain authors is tracheostomy for the deviation of nasal airflow from the skull base defect [19,27].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Endoscopic Skull Base Repair Strategy for CSF Leaks Associated with Pneumocephalus

Gâta

Toader²,

Trombitaș

et al. 2020

JCM

View full text Add to dashboard Cite

Background: Cerebrospinal (CSF) fluid leaks with associated pneumocephalus (PNC) represent a condition bearing serious risks for the patient, with little data available in the literature. Reported success rates of endoscopic skull base repair are lower when PNC is associated than in the case of simple CSF leaks. The present study represents an analysis of our experience with endoscopic management of this condition. Methods: Records of patients with pneumocephalus and associated CSF leaks, who underwent endoscopic skull base repair, were reviewed. Demographics, history, etiology of PNC, size of defect, surgical approach, reconstruction technique and complications were evaluated. Results: Twenty patients with CSF leaks and PNC underwent endonasal repair by the senior author between 2005 and 2019. Defect size was larger than 15 mm in all cases. All patients presented either worsening of PNC under conservative treatment or tension PNC. First-attempt closure of the defect was successful in all patients (100%), with resolution of the pneumocephalus. One patient developed a synechia in the proximity of the frontal ostium, as a postoperative complication. The mean follow-up was 39 months (range: 15–94 months). Conclusion: The present study represents a proposed argument for earlier endoscopic endonasal treatment in patients presenting CSF leaks and pneumocephalus.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Endoscopic Skull Base Repair Strategy for CSF Leaks Associated with Pneumocephalus

Gâta

Toader²,

Trombitaș

et al. 2020

JCM

View full text Add to dashboard Cite

show abstract

“…Numerous substrates have been used: autologous tissues, allografts, and synthetics, all with varying degrees of success documented. 2,5,6 Ideally, a vascularized graft would be used to repair such defects. Furthermore, a vascularized bone graft would be ideal for repair.…”

Section: Discussionmentioning

confidence: 99%

“…Using vascularized grafts in the reconstructive process is ideal, although the location and access to such skull defects imposes limitations. 2,5 Depending on surrounding anatomy, vascular patency, and the size of the graft site, microsurgical free flaps may provide a solution. However, the availability of suitable graft site vessels is usually limited due to the underlying disease 6 and the resections leading to the initial defect.…”

mentioning

confidence: 99%

Vascularized rotational temporal bone flap for repair of anterior skull base defects: a novel operative technique

Zeiler¹,

Kaufmann²

2015

JNS

View full text Add to dashboard Cite

Repair of anterior skull base defects with vascularized grafts poses a significant challenge, given the location and small number of adequately sized vessels for free-flap anastomosis. This is particularly the case in the setting of redo surgery or in patients with preexisting soft-tissue trauma. Even more difficult is achieving a vascularized bone flap closure of such bony defects. The authors report a novel technique involving a rotational temporal bone flap with a temporalis muscle vascularized pedicle, which was used to repair an anterior fossa bony and soft-tissue defect created by recurrent malignancy. A 55-year-old man with history of scalp avulsion during a motor vehicle accident, anterior fossa/nasopharyngeal malignant neuroendocrine carcinoma postresection, and bone flap infection presented with a recurrence of his skull base malignancy. The tumor was located in the anterior fossa, extending interhemispherically and down through the cribriform plate, ethmoid air cells, and extending into the nasopharyngeal cavity. Resection of the recurrent tumor was performed. The bony defect in the anterior skull base was repaired with a novel vascularized rotational temporal bone flap, with acceptable separation of the nasopharynx from the intracranial cavity. The vascularized rotational temporal bone flap, in which a temporalis muscle pedicle is used, provides a novel and easily accessible means of vascularized bone closure of anterior skull base defects without the need for microsurgical free-flap grafting.

show abstract

“…Once skull base infections occur, they result in repeated episodes of meningitis, subdural or intradural abscess, and can even be associated with seizures. 1 , 2 …”

Section: Introductionmentioning

confidence: 99%

Use of the Omental Free Flap for Treatment of Chronic Anterior Skull Base Infections

Kokosis

Vorstenbosch

Lombardi

et al. 2020

Plastic and Reconstructive Surgery - Global Open

Self Cite

View full text Add to dashboard Cite

Summary: Chronic complications following anterior cranial fossa tumor extirpation, such as cerebrospinal fluid leak, meningitis, mucocele, pneumocephalus, and abscess, negatively impact patient quality of life. Robust vascularized tissue is generally required to adequately reconstruct and obliterate this complex geometric space. The aim of this study was to describe outcomes and advantages of the omental flap for these defects. Following institutional review board approval, a prospective, reconstructive database was reviewed from 2011 to 2020. Four patients with chronic anterior skull base complications treated with omental flap reconstruction were identified, with chart reviews performed. Median time from the index operation until the complication ultimately required a free omental transfer was 7.3 years. All patients underwent adjuvant radiation with the indications for surgery, including cerebral abscess, recurrent meningitis, osteomyelitis, and pneumocephalus. All free flaps survived without any need for revision. There were no donor site complications. One patient had delayed healing at an adjacent nasal wound that healed secondarily. At a median follow-up of 19.4 months, none of the patients had recurrent infections. The omental free flap has a number of properties, which make it ideally suitable for anterior skull base defects. Its malleable nature combined with the presence of multiple vascular arcades enable flexibility in flap design to contour to the crevices of 3-dimensional skull base defects. Although other free flaps are available to the plastic surgeon, the versatility and reliability of the omentum make it a first-line consideration for anterior skull base reconstruction.

show abstract

Anterior and Anterolateral Resection for Skull Base Malignancies

Cited by 6 publications

References 24 publications

Endoscopic Skull Base Repair Strategy for CSF Leaks Associated with Pneumocephalus

Endoscopic Skull Base Repair Strategy for CSF Leaks Associated with Pneumocephalus

Vascularized rotational temporal bone flap for repair of anterior skull base defects: a novel operative technique

Use of the Omental Free Flap for Treatment of Chronic Anterior Skull Base Infections

Contact Info

Product

Resources

About