Classification and Microvascular Flap Selection for Anterior Cranial Fossa Reconstruction

Vargo, James; Przylecki, Wojciech H.; Camarata, Paul J.; Andrews, Brian T.

doi:10.1055/s-0038-1649520

Cited by 16 publications

(25 citation statements)

References 57 publications

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“…Cranioplasty through titanium, ceramic, or plastic implants is among the most frequently employed strategies, and most invariably requires a two-stage surgery [ 120 ]. Autogenous calvarial grafts [ 121 ] or free flaps [ 122 , 123 , 124 ] have also been described to reconstruct defects of the frontal bone.…”

Section: Treatmentmentioning

confidence: 99%

Sinonasal Squamous Cell Carcinoma, a Narrative Reappraisal of the Current Evidence

Ferrari

Taboni

Carobbio

et al. 2021

Cancers

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Sinonasal squamous cell carcinoma is a rare tumor affecting the nasal cavity and paranasal sinuses. Several aspects of this disease, ranging from epidemiology to biology, pathology, diagnosis, staging, treatment, and post-treatment surveillance are controversial, and consensus on how to manage this sinonasal cancer is lacking. A narrative literature review was performed to summarize the current evidence and provide the reader with available data supporting the decision-making process in patients affected by sinonasal squamous cell carcinoma, alongside the authors’ personal opinion on the unsolved issues of this tumor. The review has highlighted several advances in molecular definition of epithelial cancers of the sinonasal tract. Surgery represents the pivot of treatment and is performed through an endoscopic transnasal approach whenever feasible. Open surgery is required for a large proportion of cases. Reconstruction of the defect follows principles of skull base and cranio-maxillo-facial reconstruction. Chemotherapy is given as neoadjuvant treatment or concomitantly to radiotherapy. Photon-based radiation therapy has a crucial role in the adjuvant setting. Particle therapy is providing promising results. Management of the neck should be planned based on the presence of clinically appreciable metastases, primary tumor extension, and need for recipient vessels. Biotherapy and immunotherapy are still underexplored therapeutical modalities.

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Section: Treatmentmentioning

confidence: 99%

Sinonasal Squamous Cell Carcinoma, a Narrative Reappraisal of the Current Evidence

Ferrari

Taboni

Carobbio

et al. 2021

Cancers

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“…The risk of bias assessment was performed on the studies chosen for inclusion in the analysis, which excluded 1 study, resulting in a total of 13 articles included in the final analysis (Figure 1). 18,25‐36 …”

Section: Resultsmentioning

confidence: 99%

“…Many authors advocate for the routine use of vascularized tissue for reconstruction of the ventral skull base 2,18,19 . Some recent studies have found that a history of pre‐ or post‐operative radiation has no significant impact on the success of skull base reconstruction 11,20,21 .…”

Section: Introductionmentioning

confidence: 99%

The effect of prior radiation on the success of ventral skull base reconstruction: A systematic review and meta‐analysis

Yong

et al. 2021

Head & Neck

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The incidence of cerebrospinal fluid leak after ventral skull base reconstruction is a primary outcome of interest to skull base surgeons. Exposure to pre‐operative radiation may put patients at an increased risk of skull base reconstructive failure. A systematic search identified studies which included patients receiving ventral skull base reconstruction in the setting of pre‐operative radiation. A meta‐analysis using a random effects model was conducted to estimate an odds ratio of cerebrospinal fluid (CSF) leak in patients exposed to pre‐operative radiation. A meta‐analysis of 13 studies demonstrated that the odds ratio of CSF leak was 1.73 (95% CI 0.98–3.05). The majority of studies (77%) used vascularized tissue grafts for reconstruction. We identified an increased incidence of CSF leak among patients undergoing ventral skull base reconstruction after prior radiation therapy, although not of statistical significance. Skull base surgeons should exercise caution when planning reconstruction in this population.

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“…One should consider performing sinus surgery in the primary or secondary setting for these patients, which helps assist in monitoring for local recurrence and also prevents the sequela of post-radiation sinusitis. A Rains stent can be placed in the frontal outflow tract to prevent scarring during radiation treatment [22] . Low volume flaps risk nasocutaneous fistulas, which can occur due to numerous factors, including contact with contaminated paranasal sinuses, the effects of gravity, and adjuvant radiation therapy.…”

Section: Anterior Skull Basementioning

confidence: 99%

Free tissue transfer for skull base reconstruction - a review

Swendseid¹,

Chaskes²,

Philips³

et al. 2021

PAR

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Evolutions in skull base surgery and reconstructive technique have given surgeons the confidence to resect and repair increasingly advanced skull base pathologies. Free tissue transfer (FTT) provides a versatile option capable of addressing numerous simultaneous reconstructive goals. This review highlights some of the nuances, challenges, and considerations of performing FTT for skull base reconstruction in the anterior, central and lateral skull base. This review combines the expert opinion of the senior authors with those of the field at large as queried through PubMed searches regarding skull base reconstruction and FTT. Reconstructive goals include separation of intracranial from extracranial cavities, obliteration of dead space, and protection of vascular and neural structures. Atypical vascular pedicle management is commonly needed, especially for endonasal and central skull base resection. Virtual surgical planning may be beneficial for complex bony reconstruction. Familiarity with common complications such as cerebrospinal fluid leak, nasocutaneous fistula, and inferior flap displacement, as well as associations for their development, can help plan the reconstruction to minimize morbidity.

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Classification and Microvascular Flap Selection for Anterior Cranial Fossa Reconstruction

Cited by 16 publications

References 57 publications

Sinonasal Squamous Cell Carcinoma, a Narrative Reappraisal of the Current Evidence

Sinonasal Squamous Cell Carcinoma, a Narrative Reappraisal of the Current Evidence

The effect of prior radiation on the success of ventral skull base reconstruction: A systematic review and meta‐analysis

Free tissue transfer for skull base reconstruction - a review

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