Side-Door Temporoparietal Fascia Flap: A Novel Strategy for Anterior Skull Base Reconstruction

Ferrari, Marco; Vural, Alperen; Schreiber, Alberto; Mattavelli, Davide; Gualtieri, Tommaso; Taboni, Stefano; Bertazzoni, Giacomo; Rampinelli, Vittorio; Tomasoni, Michele; Buffoli, Barbara; Doglietto, Francesco; Rodella, Luigi Fabrizio; Deganello, Alberto; Nicolai, Piero

doi:10.1016/j.wneu.2019.02.056

Cited by 24 publications

(33 citation statements)

References 40 publications

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“…Feng et al ( 34 ) also recommended temporalis muscle flap as a good choice for reconstruction of the lateral skull base. It has been reported that some flaps, such as the side-door temporoparietal fascia flap and the helmet-visor pericranial flap, can be used as a new option for skull base reconstruction ( 35 , 36 ). (c) When large defects remain following tumor ablation (generally more than 4 cm in maximum diameter) or there is no available regional pedicled myofascial flap or skin defect, free flap transplantation can be used for repair.…”

Section: Discussionmentioning

confidence: 99%

Clinial Features, Individualized Treatment and Long-Term Surgical Outcomes of Skull Base Meningiomas With Extracranial Extensions

Liu

Qian

et al. 2020

Front. Oncol.

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Object: Skull base meningiomas with extracranial extensions are rarely described. This study describes the clinical features, surgical management and clinical outcomes of these rare tumors and investigates risk factors associated with progression-free survival (PFS). Methods: The clinical data of 34 consecutive patients who underwent surgery for skull base meningiomas with extracranial extensions from 2007 to 2018 were retrospectively collected and analyzed. Results: The mean patient age was 47.9 ± 13.9 years; 50.0% were male. The most common symptoms on admission were ophthalmic. All patients underwent a multidisciplinary consultation before surgery, and received individualized surgical management. The gross total resection (GTR) rate was 55.9% (19/34). Twelve patients received post-operative adjuvant radiotherapy (RT). Twelve patients experienced tumor recurrence during the follow-up period. The median PFS duration was 54 months. The mean overall survival (OS) duration was 111 months. By univariate analysis, a higher histological grade (WHO grade II and III), Ki-67 LI ≥ 5 and the extent of resection (EOR) were significantly associated with tumor recurrence. Multivariate analysis revealed Ki-67 LI ≥ 5, the EOR and adjuvant RT as prognostic factor of PFS. Conclusions: These relatively rare meningiomas are difficult to resect and have a poor prognosis; they are more common in males and have a higher histological grade than intracranial meningiomas. Multidisciplinary collaboration and individualized surgical strategies are crucial for surgically managing these complex tumors. Total removal of the tumor remains challenging. Subtotal resection (STR) or partial resection (PR) followed by RT is a reasonable strategy when radical resection is infeasible. Adjuvant RT should be recommended especially for tumors with histopathological risk factors (Ki-67 LI ≥ 5 or high histological grade).

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Section: Discussionmentioning

confidence: 99%

Clinial Features, Individualized Treatment and Long-Term Surgical Outcomes of Skull Base Meningiomas With Extracranial Extensions

Liu

Qian

et al. 2020

Front. Oncol.

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“…Compared to the pericranial flap, the TPFF carries slightly higher risk of morbidity, including facial nerve damage, alopecia, and scarring. 72 To harvest the TPFF, a hemicoronal incision made, taking care not to injure the superficial temporal artery. The temperoparietal fascia is then elevated off the temporalis muscle.…”

Section: Temporopariatel Fascia Flap (Tpff)mentioning

confidence: 99%

“…This expands the access of the flap anteriorly and laterally while obviating the need for dissection through the infratemporal fossa, thereby preserving the internal maxillary artery from harm. 72…”

Section: Tpff Outcomesmentioning

confidence: 99%

“…It is less suited for far anterior repairs because of the orientation of its pedicle, and there are significant risks of compromising important structures during flap harvest, such as the frontal branch of the facial nerve or the internal maxillary artery. Compared to the pericranial flap, the TPFF carries slightly higher risk of morbidity, including facial nerve damage, alopecia, and scarring 72 …”

Section: Extranasal Vascular Pedicled Flapsmentioning

confidence: 99%

“…Interestingly, an alternative pathway for transposition of the flap was recently proposed in which a supraorbital epidural corridor is accessed via a pterional craniotomy. This expands the access of the flap anteriorly and laterally while obviating the need for dissection through the infratemporal fossa, thereby preserving the internal maxillary artery from harm 72 …”

Section: Extranasal Vascular Pedicled Flapsmentioning

confidence: 99%

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Vascular pedicled flaps for skull base defect reconstruction

Gutierrez

Bennion

Walsh

et al. 2020

Laryngoscope Investig Oto

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Objective: Techniques for reconstruction of skull base defects have advanced greatly since the introduction of the vascular pedicled nasoseptal flap in 2006. The objective of this review is to assess the current state of the field by examining both intranasal and extranasal techniques of vascular pedicled skull base defect repair, their indications and success rates, and novel techniques that are currently under investigation. Methods: A review of the literature describing the use of vascular pedicled flaps in skull base defect reconstruction was conducted using PubMed and Google Scholar. Results: The nasoseptal flap remains the most widely used vascular pedicled flap for endoscopic repair of skull base defects. Its ease of harvest, wide arch of rotation, and high success rates make it a popular choice among surgeons. Several variations including a "rescue" nasopseptal flap have been developed. Other less commonly used pedicled intranasal flaps include the middle turbinate flap and the posterior pedicled inferior turbinate flap. Additionally, several novel vascular pedicled flaps have been developed and tested in small cohorts of patients. Extranasal flaps such as the pericranial flap and the temporoparietal fascia flap are used less frequently than intranasal flaps. However, they remain valuable options for reconstruction in certain situations. Conclusion: Advancements continue to be made in the field of skull base defect reconstruction using vascular pedicled flaps. Though the nasoseptal flap remains the most widely utilized option, additional intranasal techniques continue to be developed and tested to optimize surgical outcomes and patient care.

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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

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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.

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Side-Door Temporoparietal Fascia Flap: A Novel Strategy for Anterior Skull Base Reconstruction

Cited by 24 publications

References 40 publications

Clinial Features, Individualized Treatment and Long-Term Surgical Outcomes of Skull Base Meningiomas With Extracranial Extensions

Clinial Features, Individualized Treatment and Long-Term Surgical Outcomes of Skull Base Meningiomas With Extracranial Extensions

Vascular pedicled flaps for skull base defect reconstruction

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

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