Anterior skull base reconstruction: a review of current techniques

Schmalbach, Cecelia E.; Webb, David E.; Weitzel, Erik K

doi:10.1097/moo.0b013e32833a4706

Cited by 48 publications

(70 citation statements)

References 45 publications

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“…Rotational temporalis slings over anterior fossa defects have also been described. 2,6 However, the quality of this barrier between the nasal cavity and the anterior fossa is questionable. Finally, synthetic reconstruction in which titanium plating and a variety of bone cements are used has also been documented.…”

Section: Discussionmentioning

confidence: 99%

“…2,6 However, in previously irradiated and infected sites, these nonvascularized grafts carry a high risk of failure. Pedicled myocutaneous free flaps, typically transposed with the help of a plastic surgeon, provide a vascularized means of closure of such skull base defects and have also been reported.…”

Section: Discussionmentioning

confidence: 99%

“…Pedicled myocutaneous free flaps, typically transposed with the help of a plastic surgeon, provide a vascularized means of closure of such skull base defects and have also been reported. 6 Difficulty with recipient vessel availability, caliber, and maintenance of patency with microsurgical anastomosis in the area of the anterior fossa leave these reconstructive tissue flaps as an option, but require significant technical expertise. In the setting of previously irradiated and infected tissue beds, with multiple previous operations, these pedicled free flaps may fail.…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…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. Furthermore, an autologous vascularized bone graft can be even more difficult to find and place in such areas.…”

mentioning

confidence: 99%

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

Zeiler¹,

Kaufmann²

2015

JNS

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Zeiler¹,

Kaufmann²

2015

JNS

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A free composite de-epithelialized anterolateral thigh and the vastus lateralis muscle flap for the reconstruction of a large defect of the anterior skull base: A case report

Lo¹,

Jeng²,

Lin³

et al. 2011

Microsurgery

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Reconstruction of the anterior skull base is one of the greatest challenges for reconstructive surgeons. Sometimes, the defect is so large that a local flap is insufficient for the reconstruction. In this report, we present a case of malignant meningioma of the anterior skull base. The tumor was treated by surgical excision resulting in a large defect from the anterior skull base to the nasal cavity. The entire defect was within the cranial vault. The reconstruction was achieved using a free composite de-epithelialized anterolateral thigh and the vastus lateralis muscle flap. Postoperative monitoring included hand Doppler and daily endoscopic inspection. This patient was satisfied with the cosmetic result. After 10 months, magnetic resonance imaging (MRI), performed to assess the flap, demonstrated that the volume of the de-epithelialized skin paddle of the anterolateral thigh flap had not changed, and that there was no tissue atrophy between the patient's eyes that could have resulted in deformity.

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Free Flap Reconstruction of Anterior Skull Base Defects

Lonergan

Tjoa

2023

Skull Base Reconstruction

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Anterior skull base reconstruction: a review of current techniques

Cited by 48 publications

References 45 publications

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

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

A free composite de-epithelialized anterolateral thigh and the vastus lateralis muscle flap for the reconstruction of a large defect of the anterior skull base: A case report

Free Flap Reconstruction of Anterior Skull Base Defects

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