Vascularized Pericranial Flap for Endonasal Anterior Skull Base Reconstruction

2021 ◽  
Author(s):  
Jonathan Giurintano ◽  
Michael W. McDermott ◽  
Ivan H. El-Sayed
Keyword(s):  
Minimally Invasive ◽  
Skull Base ◽  
San Francisco ◽  
Middle Turbinate ◽  
Cranial Base ◽  
Anterior Skull Base ◽  
Craniofacial Resection ◽  
Skull Base Reconstruction ◽  
Pericranial Flap ◽  
Anterior Cranial Base

Abstract Importance As the limits of advanced skull base malignancies that can be managed through an endoscopic endonasal approach continue to be expanded, the resultant anterior skull base defects are of increasing size and complexity. In the absence of nasoseptal or turbinate flaps, the vascularized pericranial flap has been employed at our institution with excellent results. Objective The study aimed to review the outcomes of patients who underwent endonasal anterior craniofacial resection with anterior skull base reconstruction using a vascularized pericranial flap. Design Retrospective chart review of patients treated by the University of California – San Francisco minimally invasive skull base service from the years 2011 to 2017. Average duration of follow-up was 16.4 months. Setting This study was conducted at Academic tertiary referral center. Participants A total of nine patients with advanced anterior cranial base malignancies were identified who were treated with a minimally invasive, endoscopic anterior craniofacial resection from the years 2011 to 2017. Due to the nature of the resection in these patients, nasoseptal flaps and inferior/middle turbinate flaps were unavailable or insufficient for anterior skull base defect repair. Each patient underwent reconstruction of the anterior cranial base defect using an anteriorly based pericranial flap harvested by bicoronal incision, and tunneled anteriorly to the nasal cavity through a frontoethmoidal incision.

Pericranial Flap for Endoscopic Anterior Skull-Base Reconstruction

Neurosurgery ◽  
2010 ◽  
Vol 66 (3) ◽  
pp. 506-512 ◽  
Author(s):  
Mihir R. Patel ◽  
Rupali N. Shah ◽  
Carl H. Snyderman ◽  
Ricardo L. Carrau ◽  
Anand V. Germanwala ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Preoperative Planning ◽  
Cranial Base ◽  
Anterior Skull Base ◽  
Dural Defect ◽  
Skull Base Reconstruction ◽  
Pericranial Flap ◽  
Endonasal Reconstruction ◽  
Ventral Skull Base

Abstract BACKGROUND One of the major challenges of cranial base surgery is reconstruction of the dural defect and prevention of postoperative cerebrospinal fluid (CSF) fistula. The introduction of endoscopic techniques and an endonasal approach to the ventral skull base has created new challenges for reconstruction. OBJECTIVE We have developed an endoscopic pericranial flap (PCF) for skull base reconstruction and hereby present the initial cohort of patients who had endonasal reconstruction with a PCF after endoscopic skull base resection. We also demonstrate a method to radiographically incorporate anticipated skull base defects for preoperative planning of PCF length. METHODS Dural defects after endonasal skull base resection of invasive tumors were reconstructed with an onlay PCF (n = 10). We performed radiological studies to assist preoperative planning for where to make incisions while harvesting a PCF for anterior skull base, sellar, and clival defects. RESULTS Each of the 10 patients had excellent healing of their skull base and had no evidence of any postoperative cerebrospinal fluid leaks. Eight patients had radiation therapy without flap complications. Radiographic studies demonstrate that the adequate PCF length, covering defects of the anterior skull base, sellar, and clival defects are 11.31 to 12.44 cm, 14.31 to 15.57 cm, and 18.5 to 20.42 cm, respectively. CONCLUSION The PCF provides an option for endonasal reconstruction of cranial base defects and can be harvested endoscopically. Pre-operative radiographic evaluation may guide surgical planning. There is minimal donor site morbidity, and the flap provides enough surface area to cover the entire ventral skull base.

Anterior Skull Base Reconstruction With a Galeal-Pericranial Flap

2007 ◽  
Vol 18 (3) ◽  
pp. 622-625 ◽  
Author(s):  
Enrico Nastro Siniscalchi ◽  
Filippo Flavio Angileri ◽  
Paola Mastellone ◽  
Luciano Catalfamo ◽  
Maria Giusa ◽  
...  
Keyword(s):  
Skull Base ◽  
Anterior Skull Base ◽  
Skull Base Reconstruction ◽  
Pericranial Flap

Minimally invasive endoscopic pericranial flap: A new method for endonasal skull base reconstruction

2009 ◽  
Vol 119 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Adam M. Zanation ◽  
Carl H. Snyderman ◽  
Ricardo L. Carrau ◽  
Amin B. Kassam ◽  
Paul A. Gardner ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Skull Base ◽  
New Method ◽  
Skull Base Reconstruction ◽  
Pericranial Flap

scholarly journals Technical nuances of commonly used vascularised flaps for skull base reconstruction

2015 ◽  
Vol 129 (8) ◽  
pp. 752-761 ◽  
Author(s):  
I P Tang ◽  
R L Carrau ◽  
B A Otto ◽  
D M Prevedello ◽  
P Kasemsiri ◽  
...  
Keyword(s):  
Skull Base ◽  
Middle Turbinate ◽  
Cerebrospinal Fluid Leak ◽  
Lateral Wall ◽  
Cranial Base ◽  
Nasoseptal Flap ◽  
Skull Base Reconstruction ◽  
Technical Features ◽  
Fluid Leak ◽  
Temporoparietal Flaps

AbstractBackground and Methods:Reconstruction with a vascularised flap provides the most reliable outcome, with post-operative cerebrospinal fluid leak rates of less than 5 per cent. This article aims to review and summarise the critical technical aspects of the vascularised flaps most commonly used for skull base reconstruction.Results:Vascularised flaps are classified as intranasal or extranasal. The intranasal group includes the Hadad–Bassagaisteguy nasoseptal flap, the Caicedo reverse nasoseptal flap, the nasoseptal rescue flap, the posteriorly or anteriorly based lateral wall flaps, and the middle turbinate flap. Extranasal flaps include the transfrontal pericranial and transpterygoid temporoparietal flaps.Conclusion:The Hadad–Bassagaisteguy nasoseptal flap is overwhelmingly favoured for reconstructing extensive defects of anterior, middle and posterior cranial base. Its pertinent technical features are described. However, it is essential to master the skills required for the various extranasal or regional vascularised flaps because each can offer a reconstructive alternative for specific patients, especially when open approaches are needed and/or intranasal vascularised flaps are not feasible.

Pericranial Flap for Closure of Paramedian Anterior Skull Base Defects

2002 ◽  
Vol 127 (6) ◽  
pp. 494-500 ◽  
Author(s):  
Michael C. Noone ◽  
J. David Osguthorpe ◽  
Sunil Patel
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Anterior Skull Base ◽  
Cerebrospinal Fluid Leakage ◽  
Flap Reconstruction ◽  
Brain Herniation ◽  
Craniofacial Resection ◽  
Pericranial Flap ◽  
Clinically Significant ◽  
Skull Base Defects

OBJECTIVE: We sought to examine the position of a pericranial flap reconstruction of anterior skull base defects with respect to the original floor of the anterior cranial fossa. STUDY DESIGN: A retrospective chart and radiology review of 17 patients (1993–2001) with pericranial flap reconstruction for anterior skull base defects and 17 controls was performed. RESULTS: At 6 or more months after surgery, the new positions of the pericranial flaps ranged from 5 mm above to 11.3 mm below the positions of the original cribriform plates. There were no complications related to the pericranial flaps such as hemorrhage, flap loss, or brain herniation except for 2 (11.8%) cerebrospinal fluid leaks, 1 of which required operative correction. CONCLUSION: Pericranial flap reconstruction is a reliable method with low morbidity for closure of the most common skull base defect from the craniofacial resection that entails removal—unilateral or bilateral—of the fovea ethmoidalis, cribriform plate, and/or superior septum. This flap creates a watertight seal between the extradural space and the nasal cavity, prevents clinically significant brain herniation, and is associated with a low rate of cerebrospinal fluid leakage even without postoperative lumbar subarachnoid drainage of the cerebrospinal fluid.

Pericranial Flap for Endoscopic Anterior Skull Base Reconstruction: Clinical Outcomes and Radioanatomic Analysis of Preoperative Planning

Skull Base ◽  
2009 ◽  
Vol 19 (03) ◽  
Author(s):  
Mihir Patel ◽  
Rupali Shah ◽  
Carl Snyderman ◽  
Ricardo Carrau ◽  
Anand Germanwala ◽  
...  
Keyword(s):  
Skull Base ◽  
Clinical Outcomes ◽  
Preoperative Planning ◽  
Anterior Skull Base ◽  
Skull Base Reconstruction ◽  
Pericranial Flap

Pericranial Flap Anterior Skull Base Reconstruction With Gelfoam Intradural Compression

2019 ◽  
Vol 30 (4) ◽  
pp. 1280-1283
Author(s):  
Tae-wook Song ◽  
Seul-kee Lee ◽  
Tae-Sun Kim ◽  
Sung-Pil Joo
Keyword(s):  
Skull Base ◽  
Anterior Skull Base ◽  
Skull Base Reconstruction ◽  
Pericranial Flap

Expanded endoscopic endonasal transcribriform approach for resection of anterior skull base olfactory schwannoma

2012 ◽  
Vol 32 (Suppl1) ◽  
pp. E3 ◽  
Author(s):  
James K. Liu ◽  
Jean Anderson Eloy
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Tumor Resection ◽  
Cranial Base ◽  
Anterior Skull Base ◽  
Endoscopic Endonasal ◽  
Olfactory Groove ◽  
Anterior Cranial Base ◽  
Ventral Skull Base ◽  
Brain Retraction

Anterior skull base (ASB) schwannomas are extremely rare and can often mimic other pathologies involving the ASB such as olfactory groove meningiomas, hemangiopericytomas, esthesioneuroblastomas, and other malignant ASB tumors. The mainstay of treatment for these lesions is gross-total resection. Traditionally, resection for tumors in this location is performed through a bifrontal transbasal approach that can involve some degree of brain retraction or manipulation for tumor exposure. With the recent advances in endoscopic skull base surgery, various ASB tumors can be resected successfully using an expanded endoscopic endonasal transcribriform approach through a “keyhole craniectomy” in the ventral skull base. This approach represents the most direct route to the anterior cranial base without any brain retraction. Tumor involving the paranasal sinuses, medial orbits, and cribriform plate can be readily resected. In this video atlas report, the authors demonstrate their step-by-step techniques for resection of an ASB olfactory schwannoma using a purely endoscopic endonasal transcribriform approach. They describe and illustrate the operative nuances and surgical pearls to safely and efficiently perform the approach, tumor resection, and multilayered reconstruction of the cranial base defect. The video can be found here: http://youtu.be/NLtOGfKWC6U.

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