Cadaveric study for skull base reconstruction using anteriorly based inferior turbinate flap

Background Endoscopic skull base reconstruction (ESBR) is an important advance in the management of skull base defects. Large dural defects usually require the use of pedicled mucosal flaps for successful repair and prevention of cerebral spinal fluid leak. Planning for pedicled flaps is important because raising the flap is often required before tumor removal or initial surgical access. The potential utility of the inferior turbinate pedicled flap (ITPF) in ESBR is assessed. Methods The ITPF was raised in nine cadaver heads. The most anterior extent reached on the anterior cranial fossa (ACF) and inferior limit on the posterior cranial fossa (PCF) were recorded with image-guided surgery. Measurements were calculated as a percentage of ACF or PCF length from easily reproducible measurements from preoperative radiology. The width was defined as the widest measurement in the distal third. The length-to-height ratio of the skull base was also assessed as a confounding factor. Results Mean length for the ITPF was 54.0 ± 4.9 mm with a width of 22.1 ± 3.7 mm. The mean reach was 112 ± 21% (range, 90–150%) of the PCF. The ACF was less accessible with a mean reach of 67 ± 9.9% (range, 52–84%). The skull base proportions did not have a strong association on utility (p = 0.74 and 0.29). Conclusion ITPF presents one option for ESBR of larger skull base defects. It has several limitations with access to the anterior ACF. The ITPF may be an excellent salvage flap when previous septectomy has been performed or with septal involvement by tumor. Careful preoperative assessment of potential defect can estimate the reach of the ITPF.

Download Full-text

Feasibility of Piezoelectric Endoscopic Transsphenoidal Craniotomy: A Cadaveric Study

BioMed Research International ◽

10.1155/2014/341876 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Peter Valentin Tomazic ◽

Verena Gellner ◽

Wolfgang Koele ◽

Georg Philipp Hammer ◽

Eva Maria Braun ◽

...

Keyword(s):

Skull Base ◽

Cadaveric Study ◽

Bone Flap ◽

Skull Base Reconstruction ◽

Standard Procedures ◽

Primary Bone ◽

Tuberculum Sellae ◽

Time Required ◽

Planum Sphenoidale ◽

Cadaveric Model

Objective. Endoscopic transsphenoidal approach has become the gold standard for surgical treatment of treating pituitary adenomas or other lesions in that area. Opening of bony skull base has been performed with burrs, chisels, and hammers or standard instruments like punches and circular top knives. The creation of primary bone flaps—as in external craniotomies—is difficult.The piezoelectric osteotomes used in the present study allows creating a bone flap for endoscopic transnasal approaches in certain areas. The aim of this study was to prove the feasibility of piezoelectric endoscopic transnasal craniotomies.Study Design. Cadaveric study.Methods. On cadaveric specimens (N=5), a piezoelectric system with specially designed hardware for endonasal application was applied and endoscopic transsphenoidal craniotomies at the sellar floor, tuberculum sellae, and planum sphenoidale were performed up to a size of 3–5 cm2.Results. Bone flaps could be created without fracturing with the piezoosteotome and could be reimplanted. Endoscopic handling was unproblematic and time required was not exceeding standard procedures.Conclusion. In a cadaveric model, the piezoelectric endoscopic transsphenoidal craniotomy (PETC) is technically feasible. This technique allows the surgeon to create a bone flap in endoscopic transnasal approaches similar to existing standard transcranial craniotomies. Future trials will focus on skull base reconstruction using this bone flap.

Download Full-text