Neurosurgery: Skull Base Craniofacial Trauma

Donald, Paul J.

doi:10.1055/s-0036-1584816

Cited by 5 publications

(2 citation statements)

References 9 publications

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“…7 The details and efficacy of this procedure have been well documented. 8 During cranialization, the posterior wall of the frontal sinus is removed, and the nasofrontal recess is occluded with vascularized or non-vascularized tissue. The most commonly used tissue is a bifrontal pericranial flap given its close proximity to the surgical site, lack of a separate donor site, and reliable blood supply from the supratrochlear and supraorbital vessels.…”

Section: Abbreviation: Rfff Radial Forearm Free Flapmentioning

confidence: 99%

Endonasal Free Flap Reconstruction Combined With Draf Frontal Sinusotomy for Complex Cerebrospinal Fluid Leak: A Technical Report & Case Series

et al. 2021

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BACKGROUND Frontal sinus cranialization with closure via bifrontal pericranial flaps is the gold standard for separating the nasofrontal recess from the intracranial cavity for posterior table defects. Despite the high success rate, cerebrospinal fluid (CSF) leak may persist and is particularly challenging when vascularized reconstructive options from the bicoronal incision are exhausted. OBJECTIVE To assess a novel endonasal technique using an adipofascial radial forearm free flap delivered to the frontal recess through a Draf sinusotomy to repair complex CSF leaks from the frontal sinus. METHODS A retrospective review of 3 patients (all male; ages 42, 43, and 69 yr) with persistent CSF leak despite frontal sinus cranialization and repair with bifrontal pericranium was performed. Etiology of injury was traumatic in 2 patients and iatrogenic in 1 patient after anaplastic meningioma treatment. To create space for the flap and repair the nasofrontal ducts, endoscopic Draf III (Case 1, 3) or Draf IIb left frontal sinusotomy (Case 2) was performed. The forearm flap was harvested, passed through a Caldwell-Luc exposure, and placed within the Draf frontal sinustomy. The flap vessels were tunneled to the left neck and anastomosed to the facial vessels by the mandibular notch. RESULTS Intraoperatively, the flaps were well-seated and provided a watertight seal. Postoperative hospital courses were uncomplicated. There were no new CSF leaks or flap necrosis at 12, 14, and 16 mo. CONCLUSION Endoscopic endonasal free flap reconstruction through a Draf procedure is a novel viable option for persistent CSF leak after failed frontal sinus cranialization.

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Section: Abbreviation: Rfff Radial Forearm Free Flapmentioning

confidence: 99%

Endonasal Free Flap Reconstruction Combined With Draf Frontal Sinusotomy for Complex Cerebrospinal Fluid Leak: A Technical Report & Case Series

et al. 2021

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“…Craniofacial trauma may lead to a multitude of complications, such as a cerebrospinal fluid (CSF) leak, meningitis, encephalitis, mucocele, brain abscess, or encephalocele development 1,2. Traumatic encephaloceles typically form in proximity to the location of fracture dehiscence with a variety of sites previously reported, such as the orbital roof,3 paranasal sinuses,4 or temporal bone 5.…”

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confidence: 99%

Natural History of Traumatic Encephaloceles: A Systematic Literature Review

Langman

Stopa

Cuoco

et al. 2022

Journal of Craniofacial Surgery

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Encephaloceles rarely develop following traumatic skull fractures. Given their low incidence, the clinical presentations and management strategies of these lesions are confined to case reports and limited case series. A systematic literature review was performed using PubMed, Ovid, and Web of Science databases to identify relevant articles using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 37 articles met inclusion criteria, including the case presented herein. These articles reported 52 traumatic encephaloceles. Mean patient age was 25.3 years (range 6 mo-66 y) with a male predominance (63%, 33/52). The most common bony defects resulting in encephalocele formation were the orbital roof (52%, 27/52), ethmoid (35%, 18/52), and sphenoid (10%, 5/52). Mean time from traumatic injury to initial presentation was 21.3 months (range 0 d-36 y) with a bimodal distribution split between immediately following the traumatic injury (57%, 26/46) or in a delayed manner (43%, 20/46). Common presentations of orbital roof, frontonasal, and temporal bone encephaloceles were exophthalmos (85%, 23/27), cerebrospinal fluid rhinorrhea (71%, 17/24), and hearing loss (100%, 4/4), respectively. Operative approach, repair technique, and materials used for encephalocele reduction were highly variable. Surgical intervention afforded definitive symptomatic improvement or resolution in the majority of cases (89%, 42/47). Clinical outcomes did not differ between orbital, frontonasal, or temporal bone encephaloceles (P = 0.438). Traumatic encephaloceles are a rare entity with diverse presenting symptomatology dependent upon the location of fracture dehiscence. Surgical intervention affords symptomatic improvement in the majority of cases irrespective of encephalocele location, time to presentation, or operative approach.

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Complications, Outcome, and Other Aspects

Muhsen

Ibrahim

et al. 2022

Neurotrauma

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Neurosurgery: Skull Base Craniofacial Trauma

Cited by 5 publications

References 9 publications

Endonasal Free Flap Reconstruction Combined With Draf Frontal Sinusotomy for Complex Cerebrospinal Fluid Leak: A Technical Report & Case Series

Endonasal Free Flap Reconstruction Combined With Draf Frontal Sinusotomy for Complex Cerebrospinal Fluid Leak: A Technical Report & Case Series

Natural History of Traumatic Encephaloceles: A Systematic Literature Review

Complications, Outcome, and Other Aspects

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