scholarly journals RECONSTRUCTION OF LARGE ANTERIOR SKULL BASE DEFECTS AFTER RESECTION OF SINONASAL TUMORS WITH INTRACRANIAL EXTENSION BY USING PEDICLED DOUBLE FLAP TECHNIQUES

2021 ◽  
Vol 506 (1-2) ◽  
Author(s):  
Ngo Van Cong
Keyword(s):  
Skull Base ◽  
Anterior Skull Base ◽  
Intracranial Extension ◽  
Reconstruction Technique ◽  
Flap Reconstruction ◽  
Flap Technique ◽  
Sinonasal Malignancies ◽  
Csf Leakage ◽  
Skull Base Defect ◽  
Skull Base Defects

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.

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.

Use of titanium mesh for reconstruction of large anterior cranial base defects

2000 ◽  
Vol 93 (4) ◽  
pp. 711-714 ◽  
Author(s):  
Behnam Badie ◽  
J. Keith Preston ◽  
Gregory K. Hartig
Keyword(s):  
Skull Base ◽  
Anterior Skull Base ◽  
Fistula Formation ◽  
Reconstruction Technique ◽  
Titanium Mesh ◽  
Csf Rhinorrhea ◽  
Content Type ◽  
Dural Defects ◽  
Skull Base Defects ◽  
Fine Print

✓ The authors evaluated the role of titanium mesh used in combination with vascularized pericranium to provide rigid support during reconstruction of anterior skull base defects.Thirteen patients with large anterior skull base defects caused by tumor invasion or traumatic injury involving the cribriform plate, orbital roof, and planum sphenoidale were included in the study. The reconstruction technique involved placement of titanium mesh between two layers of continuous vascularized pericranium. Surgical glue and routine lumbar cerebrospinal fluid (CSF) drainage were not used in any patient.At a mean postoperative follow-up time of 22 months (range 8–39 months), none of the patients had developed infection or meningocele. Postoperative CSF rhinorrhea occurred in two patients with extensive dural defects, which resolved with temporary lumbar drainage.Use of titanium mesh and a two-layer vascularized pericranial graft is a safe, reproducible, and feasible method for reconstructing the anterior skull base. Patients with large dural defects may need temporary CSF diversion to avoid postoperative fistula formation.

scholarly journals Postoperative Cerebrospinal Fluid Leak after Septoplasty: A Potential Complication of Occult Anterior Skull Base Encephalocele

2013 ◽  
Vol 4 (1) ◽  
pp. ar.2013.4.0043 ◽  
Author(s):  
Resha S. Soni ◽  
Osamah J. Choudhry ◽  
James K. Liu ◽  
Jean Anderson Eloy
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Cerebrospinal Fluid Leak ◽  
Anterior Skull Base ◽  
Intracranial Abscess ◽  
Ethmoid Bone ◽  
Csf Rhinorrhea ◽  
Csf Leakage ◽  
Skull Base Defect ◽  
Fluid Leak

Postoperative cerebrospinal fluid (CSF) rhinorrhea after septoplasty is a known entity resulting from errors in surgical technique and improper handling of the perpendicular plate of the ethmoid bone. When these occur, urgent management is necessary to prevent deleterious sequelae such as meningitis, intracranial abscess, and pneumocephalus. Encephaloceles are rare occurrences characterized by herniation of intracranial contents through a skull base defect that can predispose patients to CSF rhinorrhea. In this report, we present a case of CSF rhinorrhea occurring 2 weeks after septoplasty likely from manipulation of an occult anterior skull base encephalocele. To our knowledge, no previous similar case has been reported in the literature. Otolaryngologists should be aware of the possibility of occult encephaloceles while performing septoplasties because minimal manipulation of these entities may potentially result in postoperative CSF leakage.

Latissimus dorsi free flap reconstruction of anterior skull base defects

2012 ◽  
Vol 40 (2) ◽  
pp. 177-179 ◽  
Author(s):  
Angélique Girod ◽  
Herve Boissonnet ◽  
Thomas Jouffroy ◽  
José Rodriguez
Keyword(s):  
Skull Base ◽  
Free Flap ◽  
Latissimus Dorsi ◽  
Anterior Skull Base ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Skull Base Defects

Double Flap Technique for Reconstruction of Anterior Skull Base Defects after Craniofacial Tumor Resection

Skull Base ◽  
2011 ◽  
Vol 21 (S 01) ◽  
Author(s):  
Lana Christiano ◽  
Dare Ajibade ◽  
Jean Eloy ◽  
James Liu
Keyword(s):  
Skull Base ◽  
Tumor Resection ◽  
Anterior Skull Base ◽  
Flap Technique ◽  
Skull Base Defects
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