Frontal Sinus Skull Base Defect Repair Using the Pedicled Nasoseptal Flap

Changing the surgical dogma in frontal sinus trauma: transnasal endoscopic repair

“…If fragments were removed and defects were larger than approximately 5 mm, an underlay epidural repair with porcine small intestine submucosal (SIS) graft (Biodesign®, Cook Medical, Bloomington, IN) was included prior to overlay graft or flap placement . Nasoseptal flaps were harvested as previously described and can cover up to 3 cm of ipsilateral posterior table defects …”

Spontaneous sphenoid lateral recess cerebrospinal fluid leaks arise from intracranial hypertension, not Sternberg's canal

“…When lumbar puncture (or ventriculostomy) was performed, the patient was placed in the lateral decubitus position and the neurosurgical or anesthesiology team obtained an opening pressure immediately after insertion. In some cases, intracranial pressure monitoring was performed via lumbar (or ventricular) drain, as described . CSF was diverted at an average of 10 mL/hour until the 2nd to 4th postoperative day (depending on surgeon preference) when the drain was clamped for 4 to 6 hours to obtain equilibrated ICP measurements.…”

The extended nasoseptal flap for coverage of large cranial base defects

“…Jones et al. describe draping the flap over the medial orbital wall after the native mucosa is removed and note a success rates of 97% in repairing frontal sinus defects . However, some defects may not be amenable to closure with this technique.…”