Reconstruction of the skull base after tumor resection: an overview of methods

2002 ◽  
Vol 12 (5) ◽  
pp. 1-5 ◽  
Author(s):  
James K. Liu ◽  
Zahid Niazi ◽  
William T. Couldwell
Keyword(s):  
Skull Base ◽  
Malignant Tumors ◽  
Tumor Resection ◽  
Infectious Complications ◽  
Skull Base Tumors ◽  
Skull Base Reconstruction ◽  
Life Threatening ◽  
Dural Defects ◽  
Reconstructive Techniques ◽  
Do So

Successful surgical management of malignant skull base tumors depends on both tumor resection and reconstruction of the cranial base defect. The primary goals of skull base reconstruction are to repair dural defects, to prevent the development of cerebrospinal fluid fistulas, and to provide a protective barrier that isolates the intracranial contents from the nasopharynx and paranasal sinuses. Failure to do so can result in potentially life-threatening infectious complications. With modern skull base and reconstructive techniques, malignant tumors in this region, which were once deemed inoperable, can now be safely removed. The authors review the different modalities available for skull base reconstruction following tumor resection.

scholarly journals Hadad-Bassagasteguy flap in skull base reconstruction – current reconstructive techniques and evaluation of criteria used for qualification for harvesting the flap

2019 ◽  
Vol 14 (2) ◽  
pp. 340-347
Author(s):  
Piotr Wardas ◽  
Michał Tymowski ◽  
Agnieszka Piotrowska-Seweryn ◽  
Jarosław Markowski ◽  
Piotr Ładziński
Keyword(s):  
Skull Base ◽  
Skull Base Reconstruction ◽  
Reconstructive Techniques

scholarly journals Endoscopic-assisted Craniofacial Resection

2011 ◽  
Vol 3 (3) ◽  
pp. 156-160
Author(s):  
Aliasgar Moiyadi ◽  
Deepa Nair ◽  
Prathamesh S Pai
Keyword(s):  
Skull Base ◽  
Tumor Resection ◽  
Additional Treatment ◽  
Anterior Skull Base ◽  
Skull Base Tumors ◽  
Craniofacial Resection ◽  
Endoscopic Endonasal ◽  
The Past ◽  
Select Group ◽  
Sinonasal Tumor

ABSTRACT Management of anterior skull base tumors has progressed steadily since AS Ketcham popularized the craniofacial surgical technique in the seventies with good results. In the past two decades, endoscopic sinonasal tumor resection has been established as an additional treatment option. For tumors that cross the anterior skull base, a cranial access is vital to encompass the tumor all around. For a select group of these transcranial lesions, the sinonasal component is suitable for an endoscopic endonasal oncologically safe resection along with a traditional transcranial access to complete the resection. This article endeavors to describe the endoscopicassisted craniofacial combining the advantages of a transnasal minimal access to reduce facial morbidity and the transcranial access for superior control of tumors with adequate margins.

Closure of large skull base defects after endoscopic transnasal craniotomy

2009 ◽  
Vol 111 (2) ◽  
pp. 371-379 ◽  
Author(s):  
Richard J. Harvey ◽  
João F. Nogueira ◽  
Rodney J. Schlosser ◽  
Sunil J. Patel ◽  
Eduardo Vellutini ◽  
...  
Keyword(s):  
Skull Base ◽  
Csf Leak ◽  
Dural Defect ◽  
Medical Centers ◽  
Dural Defects ◽  
Ventral Skull Base ◽  
Skull Base Defects ◽  
Reconstructive Techniques ◽  
Csf Leaks

Object The authors describe the utility of and outcomes after endoscopic transnasal craniotomy and skull reconstruction in the management of skull base pathologies. Methods The authors conducted a observational study of patients undergoing totally endoscopic, transnasal, transdural surgery. The patients included in the study underwent treatment over a 12-month period at 2 tertiary medical centers. The pathological entity, region of the ventral skull base resected, and size of the dural defect were recorded. Approach-related complications were documented, as well as CSF leaks, infections, bleeding-related complications, and any minor complications. Results Thirty consecutive patients were assessed during the study period. The patients had a mean age of 45.5 ± 20.2 years and a mean follow-up period of 182.4 ± 97.5 days. The dural defects reconstructed were as large as 5.5 cm (mean 2.49 ± 1.36 cm). One patient (3.3%) had a CSF leak that was managed endoscopically. Two patients had epistaxis that required further care, but there were no complications related to intracranial infections or bleeding. Some minor sinonasal complications occurred. Conclusions Skull base endoscopic reconstructive techniques have significantly advanced in the past decade. The use of pedicled mucosal flaps in the reconstruction of large dural defects resulting from an endoscopic transnasal craniotomy permits a robust repair. The CSF leak rate in this study is comparable to that achieved in open approaches. The ability to manage the skull base defects successfully with this approach greatly increases the utility of transnasal endoscopic surgery.

scholarly journals Open Anterior Skull Base Reconstruction: A Contemporary Review

2017 ◽  
Vol 31 (04) ◽  
pp. 189-196 ◽  
Author(s):  
Alfred Iloreta ◽  
Brett Miles ◽  
Jared Inman ◽  
Daniel Kwon
Keyword(s):  
Skull Base ◽  
Tumor Biology ◽  
Free Tissue Transfer ◽  
Patient Specific ◽  
Surgical Approaches ◽  
Skull Base Reconstruction ◽  
Invasive Approach ◽  
Endoscopic Techniques ◽  
Interdisciplinary Field ◽  
Reconstructive Techniques

AbstractSkull base extirpative and reconstructive surgery has undergone significant changes due to technological and operative advances. While endoscopic resection and reconstruction will continue to advance skull base surgery for the foreseeable future, traditional open surgical approaches and reconstructive techniques are still contemporarily employed as best practices in certain tumors or patient-specific anatomical cases. Skull base surgeons should strive to maintain a working knowledge and technical skill set to manage these challenging cases where endoscopic techniques have previously failed, are insufficient from anatomical constraints, or tumor biology with margin control supersedes the more minimally invasive approach. This review focuses on the reconstructive techniques available to the open skull base surgeon as an adjunct to the endoscopic reconstructive options. Anatomic considerations, factors relating to the defect or patient, reconstructive options of nonvascular grafts, local and regional flaps, and free tissue transfer are outlined using the literature and author's experience. Future directions in virtual surgical planning and emerging technologies will continue to enhance open and endoscopic skull base surgeon's preparation, performance, and outcomes in this continually developing interdisciplinary field.

Modified one-piece extended transbasal approach for resection of giant anterior skull base sinonasal teratocarcinosarcoma

2012 ◽  
Vol 32 (Suppl1) ◽  
pp. E4 ◽  
Author(s):  
James K. Liu ◽  
Jean Anderson Eloy
Keyword(s):  
Skull Base ◽  
Frontal Sinus ◽  
Malignant Tumors ◽  
Tumor Resection ◽  
Anterior Wall ◽  
Anterior Skull Base ◽  
Line Of Sight ◽  
Inferior Margin ◽  
Sinonasal Teratocarcinosarcoma ◽  
Brain Retraction

The transbasal approach is considered the workhorse for removing a variety of benign and malignant tumors of the anterior skull base. In some instances, removal of the supraorbital bar in addition to a standard bifrontal craniotomy (extended transbasal approach) allows for additional basal exposure, thereby minimizing brain retraction. In this operative video atlas report, the authors describe and demonstrate a modified one-piece extended transbasal craniotomy that incorporates the anterior wall of the frontal sinus. The inferior margin of the osteotomy is made as low as possible through the anterior wall of the frontal sinus, starting at the nasofrontal suture and extending laterally over both orbital rims by following the contour of the anterior skull base in the coronal orientation. This modification provides an excellent line of sight to the anterior skull base without any obstruction from bone overhang, which obviates the need for any supraorbital rim removal. Removal of a giant anterior skull base sinonasal teratocarcinosarcoma via the modified one-piece extended transbasal approach is demonstrated in this operative video atlas. The authors 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/x1lTtfqKIV0.

scholarly journals Endoscopic Endonasal Transplanum Transtuberculum Approach for the Resection of a Large Suprasellar Craniopharyngioma

2018 ◽  
Vol 79 (S 03) ◽  
pp. S249-S250
Author(s):  
João Mangussi-Gomes ◽  
Eduardo Vellutini ◽  
Huy Truong ◽  
Felix Pahl ◽  
Aldo Stamm
Keyword(s):  
Skull Base ◽  
Male Patient ◽  
Single Case ◽  
Tumor Resection ◽  
Magnetic Resonance Images ◽  
Endoscopic Endonasal ◽  
Skull Base Reconstruction ◽  
Cystic Component ◽  
Tertiary Center ◽  
Neurovascular Structures

Objectives To demonstrate an endoscopic endonasal transplanum transtuberculum approach for the resection of a large suprasellar craniopharyngioma. Design Single-case-based operative video. Setting Tertiary center with dedicated skull base team. Participants A 72-year-old male patient diagnosed with a suprasellar craniopharyngioma. Main Outcomes Measured Surgical resection of the tumor and preservation of the normal surrounding neurovascular structures. Results A 72-year-old male patient presented with a 1-year history of progressive bitemporal visual loss. He also referred symptoms suggestive of hypogonadism. Neurological examination was unremarkable and endocrine workup demonstrated mildly elevated prolactin levels. Magnetic resonance images demonstrated a large solid-cystic suprasellar lesion, consistent with the diagnosis of craniopharyngioma. The lesion was retrochiasmatic, compressed the optic chiasm, and extended into the interpeduncular cistern (Fig. 1). Because of that, the patient underwent an endoscopic endonasal transplanum transtuberculum approach.1 2 3 The nasal stage consisted of a transnasal transseptal approach, with complete preservation of the patient's left nasal cavity.4 The cystic component of the tumor was decompressed and its solid part was resected. It was possible to preserve the surrounding normal neurovascular structures (Fig. 2). Skull base reconstruction was performed with a dural substitute, a fascia lata graft, and a right nasoseptal flap (Video 1). The patient did well after surgery and referred complete visual improvement. However, he also presented pan-hypopituitarism on long-term follow-up. Conclusions The endoscopic endonasal route is a good alternative for the resection of suprasellar lesions. It permits tumor resection and preservation of the surrounding neurovascular structures while avoiding external incisions and brain retraction.The link to the video can be found at: https://youtu.be/zmgxQe8w-JQ.

scholarly journals Sellar trough technique for endoscopic endonasal transclival repair

2020 ◽  
Vol 11 ◽  
pp. 99
Author(s):  
Andrew K. Wong ◽  
Joseph Raviv ◽  
Ricky H. Wong
Keyword(s):  
Skull Base ◽  
Tumor Resection ◽  
Spinal Fluid ◽  
Direct Access ◽  
Endoscopic Endonasal ◽  
Skull Base Reconstruction ◽  
Ventral Skull Base ◽  
Fluid Leak ◽  
The Brain

Background: Endoscopic endonasal transclival approaches provide direct access to the ventral skull base allowing the treating of clival and paraclival pathology without the manipulation of the brain or neurovascular structures. Postoperative spinal fluid leak, however, remains a challenge and various techniques have been described to reconstruct the operative defect. The “gasket seal” has been well-described, but has anatomic challenges when applied to clival defects. We describe a modification of this technique for use in endonasal transclival approaches. Methods: Two patients who underwent an endoscopic endonasal transclival approach for tumor resection with an intraoperative spinal fluid leak underwent a modified “gasket seal” closure technique for skull base reconstruction. Results: A 71-year-old woman with a petroclival meningioma and a 22 year old with a clival chordoma underwent endoscopic endonasal transclival resection with the modified repair. No new postoperative deficits occurred and no postoperative spinal fluid leak was seen with a follow-up of 17 and 23 months, respectively. Conclusion: We describe the successful use of a simple, low risk, and technique modification of the “gasket seal” technique adapted to the clivus that allows for hard reconstruction and facilitates placement of the nasoseptal flap.

Anterior Skull Base Reconstruction following Ablative Surgery for Osteoradionecrosis: Case Report and Review of Literature

2019 ◽  
Vol 128 (12) ◽  
pp. 1134-1140 ◽  
Author(s):  
Katya Chapchay ◽  
Jeffrey Weinberger ◽  
Ron Eliashar ◽  
Neta Adler
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Skull Base ◽  
Sphenoid Sinus ◽  
Anterior Skull Base ◽  
Surgical Debridement ◽  
Anterolateral Thigh Flap ◽  
Skull Base Reconstruction ◽  
Ablative Surgery ◽  
Life Threatening ◽  
Upper Spine

Introduction: Osteoradionecrosis is one of many potentially severe complications of radiotherapy for nasopharyngeal carcinoma. Osteoradionecrosis of the skull base is life-threatening due to the critical proximity of the pathological process to vital structures, for example, the intracranial cavity, the upper spine, and major blood vessels. Reconstructive options following surgical debridement of the anterior skull base and upper spine osteonecrosis have been scarcely described in the literature. Case presentation and management: We present a rare case of osteoradionecrosis of the clivus and cervical vertebrae C1-C2 in a patient previously treated with chemoradiotherapy for nasopharyngeal carcinoma, presenting as severe soft tissue infection of the neck. Aggressive surgical debridement and reconstruction with a two-paddle free anterolateral thigh flap was performed using a combination of transcervical and transnasal endoscopic approaches. A novel endoscopic procedure in the sphenoid sinus enabled flap anchoring in this complex area. Discussion: Surgical modalities for osteoradionecrosis of the skull base and upper spine are discussed and review of the literature is presented. Conclusion: Reconstruction of the anterior skull base with a well-vascularized free flap following ablative surgery should be considered in management of life-threatening osteoradionecrosis of the area. Endoscopic opening of the sphenoid sinus and creating a funnel-shaped stem is a newly described technique that guarantees precise placement of the flap and is a valuable adjunct to the reconstructive armamentarium.

scholarly journals Intraoperative assessment of skull base tumors using stimulated Raman scattering microscopy

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Kseniya S. Shin ◽  
Andrew T. Francis ◽  
Andrew H. Hill ◽  
Mint Laohajaratsang ◽  
Patrick J. Cimino ◽  
...  
Keyword(s):  
Raman Scattering ◽  
Skull Base ◽  
Imaging Technique ◽  
Stimulated Raman Scattering ◽  
Tumor Resection ◽  
Chemical Information ◽  
Label Free ◽  
Skull Base Tumors ◽  
Fresh Tissue ◽  
Stimulated Raman

AbstractIntraoperative consultations, used to guide tumor resection, can present histopathological findings that are challenging to interpret due to artefacts from tissue cryosectioning and conventional staining. Stimulated Raman histology (SRH), a label-free imaging technique for unprocessed biospecimens, has demonstrated promise in a limited subset of tumors. Here, we target unexplored skull base tumors using a fast simultaneous two-channel stimulated Raman scattering (SRS) imaging technique and a new pseudo-hematoxylin and eosin (H&E) recoloring methodology. To quantitatively evaluate the efficacy of our approach, we use modularized assessment of diagnostic accuracy beyond cancer/non-cancer determination and neuropathologist confidence for SRH images contrasted to H&E-stained frozen and formalin-fixed paraffin-embedded (FFPE) tissue sections. Our results reveal that SRH is effective for establishing a diagnosis using fresh tissue in most cases with 87% accuracy relative to H&E-stained FFPE sections. Further analysis of discrepant case interpretation suggests that pseudo-H&E recoloring underutilizes the rich chemical information offered by SRS imaging, and an improved diagnosis can be achieved if full SRS information is used. In summary, our findings show that pseudo-H&E recolored SRS images in combination with lipid and protein chemical information can maximize the use of SRS during intraoperative pathologic consultation with implications for tissue preservation and augmented diagnostic utility.

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