Clinical Experience with Secondary Endoscopic Reconstruction of Clival Defects with Extracranial Pericranial Flaps

Göde, Sercan; Lieber, Stefan; Nakassa, Ana Carolina Igami; Wang, Eric; Fernández-Miranda, Juan C.; Gardner, Paul A.; Snyderman, Carl H.

doi:10.1055/s-0038-1668517

Cited by 19 publications

(12 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the absence of the NSF, multiple other nasal and extra-nasal flaps were described (Supplementary information 6), with their use tailored to defect sizes and location. For anterior defects: middle turbinate flaps, pericranial flaps, buccinator flap, palatal, occipital, radial (free) flaps or vastus lateralis (free) flaps were used [ 31 , 120 , 121 , 128 – 133 ]. For posterior/clival defects, options included the temporoparietal flap and inferior turbinate flaps [ 31 , 120 , 132 , 134 ].…”

Section: Resultsmentioning

confidence: 99%

“…For anterior defects: middle turbinate flaps, pericranial flaps, buccinator flap, palatal, occipital, radial (free) flaps or vastus lateralis (free) flaps were used [ 31 , 120 , 121 , 128 – 133 ]. For posterior/clival defects, options included the temporoparietal flap and inferior turbinate flaps [ 31 , 120 , 132 , 134 ]. Other options included the lateral nasal wall, sellar floor, superior turbinate, “U” inverted rhinopharyngeal and nasopharyngeal (mucosal and muscle) flaps [ 28 , 59 , 135 , 136 ].…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review

et al. 2021

View full text Add to dashboard Cite

Purpose Postoperative cerebrospinal fluid rhinorrhoea (CSFR) remains a frequent complication of endonasal approaches to pituitary and skull base tumours. Watertight skull base reconstruction is important in preventing CSFR. We sought to systematically review the current literature of available skull base repair techniques. Methods Pubmed and Embase databases were searched for studies (2000–2020) that (a) reported on the endonasal resection of pituitary and skull base tumours, (b) focussed on skull base repair techniques and/or postoperative CSFR risk factors, and (c) included CSFR data. Roles, advantages and disadvantages of each repair method were detailed. Random-effects meta-analyses were performed where possible. Results 193 studies were included. Repair methods were categorised based on function and anatomical level. There was absolute heterogeneity in repair methods used, with no independent studies sharing the same repair protocol. Techniques most commonly used for low CSFR risk cases were fat grafts, fascia lata grafts and synthetic grafts. For cases with higher CSFR risk, multilayer regimes were utilized with vascularized flaps, gasket sealing and lumbar drains. Lumbar drain use for high CSFR risk cases was supported by a randomised study (Oxford CEBM: Grade B recommendation), but otherwise there was limited high-level evidence. Pooled CSFR incidence by approach was 3.7% (CI 3–4.5%) for transsphenoidal, 9% (CI 7.2–11.3%) for expanded endonasal, and 5.3% (CI 3.4–7%) for studies describing both. Further meaningful meta-analyses of repair methods were not performed due to significant repair protocol heterogeneity. Conclusions Modern reconstructive protocols are heterogeneous and there is limited evidence to suggest the optimal repair technique after pituitary and skull base tumour resection. Further studies are needed to guide practice.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review

et al. 2021

View full text Add to dashboard Cite

show abstract

“…This flap is then brought through into the nasal cavity via a bony defect drilled in the nasion (49). Following this, it can be used to cover osteodural defects in an identical manner to the NSF and it has been successfully utilized in the reconstruction of anterior and posterior fossa skull base defects (50,51).…”

Section: Alternative Optionsmentioning

confidence: 99%

Methods of Skull Base Repair Following Endoscopic Endonasal Tumor Resection: A Review

2020

View full text Add to dashboard Cite

Following the introduction of fully endoscopic techniques for the resection of pituitary tumors, there was a rapid expansion of the indications for endonasal endoscopic surgery to include extrasellar tumors of the skull base. These techniques offer significant advantages over traditional open surgical approaches to the skull base, including improved tumor resection, and better post-operative neurological outcomes. Following their introduction, however, the initial rate of post-operative CSF leak was unacceptably high. Post-operative CSF leak following skull base surgery is a major source of morbidity, and can lead to the development of life-threatening intracranial infection. The use of vascularized naso-septal flaps transformed the management of these patients, significantly reducing the rate of post-operative CSF leak and increasing the number of patients that could benefit from this less invasive treatment modality. Adequate repair of iatrogenic defects in the skull base is of crucial importance for patients with skull base tumors, as the development of a post-operative CSF leak, and the associated complications can significantly delay the administration of the adjunctive oncological therapies these patients require. In this review, we provide an overview of the latest evidence regarding skull base reconstruction following endoscopic skull base surgery, and describe the skull base repair technique in use at our institution.

show abstract

“…While utilizing the endoscopic pericranial flap for ASBD reconstruction after EEEA, harvesting the TPFF with sufficient length is challenging for clinicians 12,13 . The average length of pericranial flap needed to provide complete ASBD coverage was reported to be between 113.1 and 124.4 mm, and limited flap dimension was also a consideration 12,24 . Nonetheless, this problem is easily managed by applying transorbital transposition of the TPFF through the superior orbital corridor.…”

Section: Discussionmentioning

confidence: 99%

Transorbital transposition of the temporoparietal fascia flap to reconstruct the skull base defects: A preclinical study with comparison to the transpterygoid transposition

Lin

Hueng

et al. 2023

Head & Neck

View full text Add to dashboard Cite

BackgroundTranspterygoid transposition of the temporoparietal fascia flap (TPFF) is a feasible selection for ventral skull base defect (VSBD) reconstruction, but not anterior skull base defect (ASBD) reconstruction, after expanded endoscopic endonasal approach (EEEA). The goal of this study is to introduce the transorbital transposition of the TPFF for skull base defects reconstruction after EEEA, and make quantitative comparison between the transpterygoid transposition and transorbital transposition.MethodsCadaveric dissections were performed in five adult cadaveric heads with creating three transporting corridors bilaterally, encompassing superior transorbital corridor, inferior transorbital corridor, and transpterygoid corridor. For each transporting corridor, the minimum necessary length of the TPFF for skull base defects reconstruction was measured.ResultsThe areas of ASBD and VSBD were 1019.63 ± 176.32 mm2 and 572.99 ± 126.21 mm2. The length of the harvested TPFF was 149.38 ± 6.21 mm. In contrast to the transpterygoid transposition with incomplete coverage, transorbital transposition of the TPFF allowed full coverage of ASBD with a minimum necessary length of 109.75 ± 8.31 mm. For VSBD reconstruction, transorbital transposition of the TPFF needs shorter minimum necessary length (123.88 ± 4.49 mm) than transpterygoid transposition (138.00 ± 6.28 mm).ConclusionsTransorbital corridor is a novel pathway for transporting the TPFF into the sinonasal cavity for skull base defects reconstruction after EEEA. In comparison with transpterygoid transposition, transorbital transposition provides wider coverage of skull base defects with a fixed length of the TPFF.

show abstract

Clinical Experience with Secondary Endoscopic Reconstruction of Clival Defects with Extracranial Pericranial Flaps

Cited by 19 publications

References 21 publications

Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review

Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review

Methods of Skull Base Repair Following Endoscopic Endonasal Tumor Resection: A Review

Transorbital transposition of the temporoparietal fascia flap to reconstruct the skull base defects: A preclinical study with comparison to the transpterygoid transposition

Contact Info

Product

Resources

About