Efficacy of simultaneous pericranial and nasoseptal “double flap” reconstruction of anterior skull base defects after combined transbasal and endoscopic endonasal approaches

Gabriel, Phabinly; Kohli, Gurkirat; Hsueh, Wayne D.; Eloy, Jean Anderson; Liu, James K.

doi:10.1007/s00701-019-04155-1

Cited by 15 publications

(9 citation statements)

References 30 publications

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“…In extensive fractures with large dural defects, multilayered combined repair can be effective in preventing brain sag and high-flow CSF leakage. 6,7,17) Our technique uses a periosteal flap, free fascial flap inlay, free fat graft, and nasoseptal flap and was effective in all patients, resulting in immediate and complete cessation of CSF leakage. This secure reconstruction technique can allow early ambulation and be beneficial in patients who are unable to maintain bedrest.…”

Section: Discussionmentioning

confidence: 99%

Combined Transcranial-endonasal Reconstructive Surgery for Cerebrospinal Fluid Leakage Resulting from Traumatic Anterior Skull Base Fractures Involving the Parasellar Region

Kondo

Kishida

Watanabe

et al. 2021

Neurol. Med. Chir.(Tokyo)

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Extensive traumatic anterior skull base fractures from the frontal sinus to the parasellar region are frequently accompanied by multiple dural defects that cause persistent cerebrospinal fluid (CSF) leakage. Conventional transcranial reconstruction using a frontal periosteal flap is frequently insufficient, and parasellar dural defects are often deep, complex, and difficult to identify. In this report, we describe a combined transcranial-endonasal reconstructive technique and report our experience. Simultaneous combined transcranial and endoscopic surgery was performed in three patients with CSF leakage resulting from traumatic anterior skull base fractures. Dural defects were thoroughly identified from the transcranial and endonasal surgical fields, and covered using a multilayer sealing technique. The anterior regions of the anterior skull base were reconstructed using a free fascial flap and frontal periosteal flap; posterior and parasellar regions were reconstructed using a fat graft, vascularized nasoseptal flap, and endonasal balloon. Suturing the transcranial grafts to the parasellar dura mater was performed collaboratively by the transcranial and endonasal surgeons. In our cases, complete cessation of CSF leakage was achieved without perioperative lumbar drainage in all patients. Mean time to postoperative ambulation was 7 days (range, 3-11). No surgical complications occurred. Simultaneous transcranial and endonasal procedures were helpful to detect all sites of CSF leakage and secure reconstructive grafts. The combined transcranial and endonasal reconstructive technique achieved secure skull base reconstruction without recurrence of CSF leakage, and allowed early postoperative ambulation. This technique can be a reliable surgical option to repair CSF leakage resulting from extensive anterior skull base fractures.

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Section: Discussionmentioning

confidence: 99%

Combined Transcranial-endonasal Reconstructive Surgery for Cerebrospinal Fluid Leakage Resulting from Traumatic Anterior Skull Base Fractures Involving the Parasellar Region

Kondo

Kishida

Watanabe

et al. 2021

Neurol. Med. Chir.(Tokyo)

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“…This is consistent with other studies. 37 , 38 The number of anatomical localizations of the skull base defect was shown to be of little significance for anterior skull base defect reconstruction in cases of non-tumor CSF leaks. 39 In our study, each additional localization increased the risk of CSF leak only by 2% with the maximal value of 24% for all possible 12 localizations.…”

Section: Discussionmentioning

confidence: 99%

Predictive model for preoperative risk calculation of cerebrospinal fluid leak after resection of midline craniofacial mass lesions

Gol'bin

Vecherin

Cherekaev

et al. 2023

World Neurosurgery: X

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“…Radiotherapy have been reported to result in partial or total local ap loss in up to 7-20% of patients [13]. Therefore, when large three-dimensional composite defects are encountered, microvascular free tissue transfer may be more suitable.…”

Section: Discussionmentioning

confidence: 99%

Free flap transfer, a safe and efficient method for reconstruction of composite skull base defects after salvage resection of advanced intra- and extracranial communicating tumors

Liu

Qian

et al. 2021

Preprint

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Propose: Surgical treatment of advanced intra- and extracranial communicating skull base tumors is challenging, especially for the reconstruction of the large composite defect left by tumor resection. The aim of the study is to evaluate the utility of the free flap reconstruction of the defects resulting from radical resection of these tumors. Methods: The clinical data of 17 consecutive patients who underwent free flap reconstruction for defect left by salvage resection of advanced intra- and extracranial communicating tumors from 2013 to 2019 were retrospectively collected and analyzed. Results: There were 5 squamous cell carcinomas, 4 adenoid cystic carcinomas, 2 basal cell carcinomas, 2 meningiomas, 1 anaplastic hemangiopericytoma, 1 pleomorphic adenoma, 1 osteosarcoma and 1 chondrosarcoma. All patients had recurrent neoplasms, 2 of which had pulmonary metastasis. A modified radical cervical dissection was performed in 6 patients. The anterolateral thigh flap myocutaneous (ALT) flap and rectus abdominis myocutaneous (RAM) flap were used in 15 patients (88.2%) and 2 patients (11.8%), respectively. Complications were seen in 3 of 17 patients (17.6%) with 1 total flap loss. The median PFS duration was 31 months. The 3- and 5-year PFS rate was 0.47 and 0.24, respectively. The mean OS duration was 66 months. The 3- and 5-year OS rate was 0.85 and 0.68, respectively. Conclusion: Free flap transfer is a safe and effective method with acceptable complications, useful for reconstruction of large composite skull base defects after salvage resection of advanced intra- and extracranial communicating tumors. The functional and cosmetic results are satisfying.

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Efficacy of simultaneous pericranial and nasoseptal “double flap” reconstruction of anterior skull base defects after combined transbasal and endoscopic endonasal approaches

Cited by 15 publications

References 30 publications

Combined Transcranial-endonasal Reconstructive Surgery for Cerebrospinal Fluid Leakage Resulting from Traumatic Anterior Skull Base Fractures Involving the Parasellar Region

Combined Transcranial-endonasal Reconstructive Surgery for Cerebrospinal Fluid Leakage Resulting from Traumatic Anterior Skull Base Fractures Involving the Parasellar Region

Predictive model for preoperative risk calculation of cerebrospinal fluid leak after resection of midline craniofacial mass lesions

Free flap transfer, a safe and efficient method for reconstruction of composite skull base defects after salvage resection of advanced intra- and extracranial communicating tumors

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