Anterior Skull Base Reconstruction with Fascia Lata Strip: The Champagne Cork Technique

Object The goal of this study was to demonstrate the efficacy of a simple and reliable technique for anterior skull base and craniofacial reconstruction in patients who have undergone excision of tumors via the subcranial approach. Methods There were 63 patients who had undergone 71 anterior skull base resections of tumors via the aforementioned approach. Twenty-nine cases (41%) involved malignant tumors and 42 (59%) involved benign tumors. Reconstruction of the anterior skull base was performed by a single team who used double-layer fascial graft. Limited dural defects were reconstructed using the temporalis fascia, whereas large anterior skull base defects were reconstructed using a fascia lata sheath. Reconstruction was achieved without the support of bone graft or titanium mesh and without pericranial, galeal, or free flaps. Pericranial flap wrapping of the frontonasoorbital segment was performed to prevent osteoradionecrosis if postoperative radiotherapy was planned. The incidence of cerebrospinal fluid (CSF) leakage, intracranial infection, and tension pneumocephalus was 5.6%. Histopathological examination of fascia lata grafts obtained in patients who had undergone a second procedure demonstrated integration of vascularized fibrous tissue to the graft, as well as local proliferation of a newly formed vascular layer embedding the fascial sheath. Conclusions The use of a double-layer fascial graft alone was adequate for prevention of CSF leakage, meningitis, tension pneumocephalus, and brain herniation. The double-layer fascial flap provided a simple and reliable means for anterior skull base reconstruction after en bloc resection of both malignant and benign tumors.

Download Full-text

The Corkscrew Technique – A Minimally Invasive, Trans-nasal Anterior Skull Base Reconstruction Using a Wedge-shaped Construct for Treatment of Cerebro-Spinal Fluid Leak

10.21203/rs.3.rs-707136/v1 ◽

2021 ◽

Author(s):

Yazid Samih Badarny ◽

Iddo Paldor ◽

Samih Badarny ◽

Ziv Gil ◽

Gill Sviri

Keyword(s):

Skull Base ◽

Lateral Displacement ◽

Standard Technique ◽

Fascia Lata ◽

Anterior Skull Base ◽

Spinal Fluid ◽

Csf Leak ◽

Transnasal Approach ◽

Skull Base Reconstruction ◽

Csf Leakage

Abstract Background : Cerebro-spinal fluid rhinorrhea may follow surgical and traumatic events, and may be spontaneous. Various techniques have been employed for reconstruction of the skull base following a CSF leak. Recent years have seen the development of endoscopic, transnasal techniques for reconstruction of the anterior skull base. We describe our experience with a novel corkscrew technique (CST), which entails harvesting a fascia lata graft, and placement of a wedge-shaped construct above the aperture in the skull base dura. This technique serves to prevent dislodgement of the construct extracranially, and lateral displacement of the construct away from the opening. Methods : We operated 28 cases of CSF leak, in 26 patients, with a transnasal endoscopic approach. Twelve were operated using the CST and 16 with standard technique (ST), with a mean follow-up of over 5 years.Results : The success rate in alleviating the leak was 91.7% in the CST group, and 87.5% in the ST group. Altogether, our complication rate was 8.3% in the CST group, and 37.5% in the ST group. None of the differences were statistically significant. Conclusions : We recommend the use of a wedge-shaped, fascia lata based construct for transnasal endoscopic repair of anterior skull base CSF leaks. Keywords: rhinorrhea, pituitary adenoma, CSF leakage, endoscopic transnasal approach, fascia lata.

Download Full-text

Skull Base Reconstruction with Multilayered Fascia Lata: A Single-Center 17 Years Experience

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-3402013 ◽

2020 ◽

Author(s):

Barak Ringel ◽

Avraham Abergel ◽

Gilad Horowitz ◽

Ahmad Safadi ◽

Arik Zaretski ◽

...

Keyword(s):

Skull Base ◽

Donor Site ◽

Fascia Lata ◽

Anterior Skull Base ◽

Complication Rates ◽

Safe Procedure ◽

Skull Base Reconstruction ◽

Recipient Site ◽

Fascia Lata Graft ◽

Skull Base Lesions

Abstract Objectives Reconstruction after open surgery of anterior skull base lesions is challenging. The fascia lata graft is our workhorse for achieving dural sealing and preventing cerebrospinal fluid leak and meningitis. This study seeks to analyze the donor and recipient site complication rates after fascia lata reconstruction. Methods This is a retrospective review of all open anterior skull base operations in which a double-layer fascia lata graft was used for the reconstruction of the defect from 2000 to 2016 at the Tel-Aviv Sourasky Medical Center, a tertiary referral center in Israel. Results Of the 369 patients operated for skull base lesions, 119 underwent open anterior skull base surgery and were reconstructed with a fascia lata graft. The patients' mean age was 47.1 years, and 68 (57.1%) were males. The overall postoperative early and late donor site complication rates were 6.7% (n = 8) and 5.9% (n = 7), respectively. Multivariate analysis found minor comorbidities and persistent/recurrent disease as being predictors for early-term complications. The overall postoperative early central nervous system (CNS) complication rate was 21.8% (n = 26), while 12.6% (n = 15) of the patients had late postoperative CNS complications. Conclusion Reconstruction of open anterior skull base lesions with fascia lata grafting is a safe procedure with acceptable complication and donor site morbidity rates.

Download Full-text

Janus flap: Bilateral nasoseptal flaps for anterior skull base reconstruction

Yearbook of Neurology and Neurosurgery ◽

10.1016/s0513-5117(10)79312-1 ◽

2010 ◽

Vol 2010 ◽

pp. 296

Author(s):

J.K. Liu

Keyword(s):

Skull Base ◽

Anterior Skull Base ◽

Skull Base Reconstruction

Download Full-text

Vascularized bone flap for anterior skull base reconstruction

Acta Neurochirurgica ◽

10.1007/bf01400668 ◽

1994 ◽

Vol 128 (1-4) ◽

pp. 166-168 ◽

Cited By ~ 19

Author(s):

A. Goel

Keyword(s):

Skull Base ◽

Anterior Skull Base ◽

Bone Flap ◽

Skull Base Reconstruction ◽

Vascularized Bone

Download Full-text

Hidden Port Approach to Endoscopic Pericranial Scalp Flap for Anterior Skull Base Reconstruction

The Laryngoscope ◽

10.1002/lary.29407 ◽

2021 ◽

Author(s):

Alfredo García‐Fernández ◽

Esther García‐González ◽

Igor Paredes‐Sansinenea ◽

Víctor Rodríguez‐Berrocal ◽

José Fernández‐Alén ◽

...

Keyword(s):

Skull Base ◽

Anterior Skull Base ◽

Skull Base Reconstruction ◽

Scalp Flap

Download Full-text

Use of the external pectoralis myocutaneous major flap in anterior skull base reconstruction

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.ijom.2012.10.038 ◽

2013 ◽

Vol 42 (4) ◽

pp. 453-457 ◽

Cited By ~ 6

Author(s):

Natacha Kadlub ◽

Joseph H. Shin ◽

Doug A. Ross ◽

T. Della Torre ◽

Edward Ansari ◽

...

Keyword(s):

Skull Base ◽

Anterior Skull Base ◽

Skull Base Reconstruction

Download Full-text

Combined endoscopy-assisted cranionasal approach for resection of infantile myofibromatosis of the ethmoid and anterior skull base

Journal of Neurosurgery Pediatrics ◽

10.3171/ped/2008/2/7/058 ◽

2008 ◽

Vol 2 (1) ◽

pp. 58-62 ◽

Cited By ~ 10

Author(s):

Ercole Galassi ◽

Ernesto Pasquini ◽

Giorgio Frank ◽

Gianluca Marucci

Keyword(s):

Skull Base ◽

Skull Base Surgery ◽

Radical Resection ◽

Permanent Tooth ◽

Anterior Skull Base ◽

Facial Growth ◽

Endoscopic Endonasal ◽

Skull Base Reconstruction ◽

Endoscopic Techniques ◽

Tooth Roots

The advent and widespread development of endonasal endoscopic techniques have recently expanded the frontiers of skull base surgery. The reduced invasiveness, wider and adjustable visualization of the operative field, and lack of postoperative cosmetic defects are well-known advantages of the endonasal endoscopic approaches compared with traditional surgical exposures both in adults and in children. The need to avoid disruption of facial growth centers and permanent tooth roots represents a further special consideration in favor of these endoscopic techniques in children. The authors report on a case of solitary myofibroma involving the ethmoid, mesial orbits, and anterior skull base with intracranial intradural expansion in a 17-month-old girl. The occurrence of such proliferative disease along the skull base is exceedingly rare. The tumor was successfully excised via an endoscopy-assisted cranionasal approach in which a transcranial microsurgical exposure was combined with endonasal endoscopic access to ensure a radical resection and optimize skull base reconstruction. To the authors' knowledge, the patient in this case is the youngest reported patient in the literature who has undergone treatment with this surgical strategy. The outcome in this patient underscores the feasibility and safety of endoscopic endonasal surgery even in toddlers and early childhood.

Download Full-text