Double flap technique for reconstruction of anterior skull base defects after craniofacial tumor resection: technical note

Background: Surgical resection of a large anterior skull base (ASB) tumor and sinonasal maglinancies with intracranial extension will result a large skull base defect. Reconstruction of large ASB defects by using traditional techniques may result in high risk of postoperative CSF leakage, meningitis and increase mortality rate. The use of pedicled double flap technique to reconstruct the anterior skull base defect may decrease the complications. In this study, we examine the clinical outcomes of patients who underwent this double flap reconstruction technique after the resection of sinonasal malignancies with significant intracranial extension at Cho Ray hospital, Vietnam. Methods: Case series study was conducted at Cho Ray hospital from 09/2010 to 09/2020. All patients with large sinonasal malignancies with intracranial invasion underwent combined transbasal - EEA approach. Reconstruction of large skull base defect ( > 2 cm ) was followed by using the pedicled double flap technique. Results: There were 75 patients who underwent the modified multi-layer with double flap reconstruction technique after the resection of ASB tumor from 09/2010 to 09/2020. The skull base defects were commonly seen at the horizontal plate of the ethmoid and the roof of the ethmoid ( 98.6%). The large skull base defects ( > 2cm) accounted for 81.3%. The risk of postoperative CSF leakage after double flap repair was very low. In this study, we had 1 patient with postoperative CSF leakage and 1 patient had postoperative meningitis. Conclusion: The use of two vascularize pedicled flap may decrease the incidence of postoperative cerebral spinal fluid (CSF) leakage and meningitis. This technique is an effective method for the reconstruction of the ASB with large defect.

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Endoscopic Endonasal Repair of Anterior Skull Base Defects: The Initial Experience at LSU HSC Shreveport

10.1055/s-0039-1679685 ◽

2019 ◽

Author(s):

Jennifer Kosty ◽

Lori Lemonnier ◽

Papireddy Bollam ◽

Bharat Guthikonda

Keyword(s):

Skull Base ◽

Anterior Skull Base ◽

Initial Experience ◽

Endoscopic Endonasal ◽

Skull Base Defects

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Preservation of nasal turbinates in endoscopic, anterior skull base surgery—yes, we can!

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-021-06856-9 ◽

2021 ◽

Author(s):

Axel Wolf ◽

Alexandros Andrianakis ◽

Peter Valentin Tomazic ◽

Michael Mokry ◽

Georg Clarici ◽

...

Keyword(s):

Skull Base ◽

Skull Base Surgery ◽

Tumor Resection ◽

Tumor Location ◽

Anterior Skull Base ◽

Tumor Diameter ◽

Tumor Type ◽

Preoperative Information ◽

Medical University ◽

Significant Factors

Abstract Objective To evaluate the frequency, type and indications of nasal turbinate (NT) resection during endoscopic, anterior skull base surgery and to analyze factors that may have an impact on the need of NT removal. Methods In this retrospective cohort study, 306 subjects (150 males and 156 females, mean age 55.4 ± 15.3 years) who underwent multidisciplinary, transnasal, endoscopic tumor surgery of the anterior skull base using 4-handed techniques between 2011 and 2019 at the Department of Otorhinolaryngology, Medical University of Graz, were included. Results In the majority of interventions (n = 281/306; 91.8%), all NT were preserved. Significant factors influencing the need of NT resections turned out to be type of endoscopic approach (p < 0.001; V = 0.304), sagittal (p = 0.003; d = 0.481) and transversal (p = 0.017; d = 0.533) tumor diameter, tumor type (p < 0.001; V = 0.355) and tumor location (p < 0.001; V = 0.324). Conclusions NT can be preserved in the majority of patients undergoing tumor resection in anterior, transnasal, skullbase surgery and routine resection of NT should be avoided. Variables that have an impact on the need of NT resections are types of endoscopic approaches, sagittal and transversal tumor extension and tumor type. These factors should be considered in planning of surgery and preoperative information of patients.

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