scholarly journals Anterior skull base reconstruction using an anterolateral thigh free flap

2021 ◽  
Vol 22 (5) ◽  
pp. 232-238
Author(s):  
Shin Hyun Kim ◽  
Won Jai Lee ◽  
Jong Hee Chang ◽  
Joo Hyung Moon ◽  
Seok Gu Kang ◽  
...  
Keyword(s):  
Skull Base ◽  
Free Flap ◽  
Free Flaps ◽  
Anterior Skull Base ◽  
Temporalis Muscle ◽  
Muscle Flaps ◽  
Skull Base Reconstruction ◽  
Anterolateral Thigh ◽  
Effective Option ◽  
Skull Base Defects

Background: Galeal or temporalis muscle flaps have been traditionally used to reconstruct skull base defects after tumor removal. Unfortunately, these flaps do not provide sufficient vascularized tissue for a dural seal in extensive defects. This study describes the successful coverage of large skull base defects using anterolateral thigh (ALT) free flaps.Methods: This retrospective study included five patients who underwent skull base surgery between June 2018 and June 2021. Reconstruction was performed using an ALT free flap to cover defects that included the intracranial space and extended to the frontal sinus and cribriform plate.Results: There were no major complications, such as ascending infections or cerebrospinal leakage. Postoperative magnetic resonance imaging showed that the flaps were well-maintained in all patients.Conclusion: Successful reconstruction was performed using ALT free flaps for large anterior skull base defects. In conclusion, the ALT free flap is an effective option for preventing communication between the nasal cavity and the intracranial space.

Anterolateral Thigh Flap for Skull Base Reconstruction

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P30-P30
Author(s):  
Matthew M Hanasono ◽  
Neha Goel ◽  
Martina Ayad ◽  
Roman Skoracki ◽  
Justin Michael Sacks
Keyword(s):  
Skull Base ◽  
Free Flap ◽  
Donor Site ◽  
Csf Leak ◽  
Anterolateral Thigh Flap ◽  
Wound Complications ◽  
Skull Base Reconstruction ◽  
Anterolateral Thigh ◽  
Facial Reanimation ◽  
Skull Base Defects

Objective 1) Review our experience with the anterolateral thigh (ALT) free flap in skull base reconstruction. 2) Describe reconstructive techniques for skull base defects and dural coverage with simultaneous facial reanimation. Methods A retrospective review was performed for 25 consecutive patients with defects of the skull base who were reconstructed with the ALT free flap. Results Reconstructed sites consisted of 2 anterior, 7 lateral, and 16 posterior skull base defects. Neoadjuvant and adjuvant radiotherapy (RT) was administered to 32% and 36% of the patients, respectively. The overall complication rate was 36% (66% recipient site and 34% donor site). One patient developed a CSF leak and one a nasocutaneous fistula. RT was associated with a two-fold increase in wound complications relative to controls. There were no flap losses and no long-term donor site probleMS 3 nerve grafts using the lateral femoral cutaneous nerve and 12 static slings for facial reanimation using the tensor fascia lata were performed simultaneously with free flap reconstruction from the same donor site. 4 gold eyelid weights, 2 lateral canthoplasties, and 3 direct browlifts were also performed simultaneously. Conclusions The ALT free flap provides reliable and versatile reconstruction of skull base defects. Primary advantages of this flap reside in the ability to harvest variable amounts of skin and vastus lateralis muscle along with nerve and fascial grafts from the same operative site, minimizing operative time and donor site morbidity. In our practice, the ALT flap represents a first-line option for composite skull base defects.

Vascularized rotational temporal bone flap for repair of anterior skull base defects: a novel operative technique

2015 ◽  
Vol 123 (5) ◽  
pp. 1312-1315 ◽  
Author(s):  
Frederick A. Zeiler ◽  
Anthony M. Kaufmann
Keyword(s):  
Soft Tissue ◽  
Skull Base ◽  
Temporal Bone ◽  
Free Flap ◽  
Anterior Skull Base ◽  
Bone Flap ◽  
Temporalis Muscle ◽  
Anterior Fossa ◽  
Skull Base Defects ◽  
Vascularized Bone

Repair of anterior skull base defects with vascularized grafts poses a significant challenge, given the location and small number of adequately sized vessels for free-flap anastomosis. This is particularly the case in the setting of redo surgery or in patients with preexisting soft-tissue trauma. Even more difficult is achieving a vascularized bone flap closure of such bony defects. The authors report a novel technique involving a rotational temporal bone flap with a temporalis muscle vascularized pedicle, which was used to repair an anterior fossa bony and soft-tissue defect created by recurrent malignancy. A 55-year-old man with history of scalp avulsion during a motor vehicle accident, anterior fossa/nasopharyngeal malignant neuroendocrine carcinoma postresection, and bone flap infection presented with a recurrence of his skull base malignancy. The tumor was located in the anterior fossa, extending interhemispherically and down through the cribriform plate, ethmoid air cells, and extending into the nasopharyngeal cavity. Resection of the recurrent tumor was performed. The bony defect in the anterior skull base was repaired with a novel vascularized rotational temporal bone flap, with acceptable separation of the nasopharynx from the intracranial cavity. The vascularized rotational temporal bone flap, in which a temporalis muscle pedicle is used, provides a novel and easily accessible means of vascularized bone closure of anterior skull base defects without the need for microsurgical free-flap grafting.

Radial Forearm Free Flap With Titanium Mesh Sandwich Reconstruction in Complex Anterior Skull Base Defects

2012 ◽  
Vol 23 (6) ◽  
pp. 1763-1765 ◽  
Author(s):  
Vincent L. Biron ◽  
Menachem Gross ◽  
Robert Broad ◽  
Hadi Seikaly ◽  
Erin D. Wright
Keyword(s):  
Skull Base ◽  
Free Flap ◽  
Anterior Skull Base ◽  
Radial Forearm Free Flap ◽  
Titanium Mesh ◽  
Radial Forearm ◽  
Skull Base Defects

scholarly journals Stepwise Algorithm for Skull Base Reconstruction in Endoscopic Endonasal Surgery: From the Simple to the Complex

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Maria Belen Vega ◽  
Philippe Lavigne ◽  
Vanessa Hernandez-Hernandez ◽  
Aldo Eguiluz-Menendez ◽  
Eric Wang ◽  
...  
Keyword(s):  
Skull Base ◽  
Posterior Fossa ◽  
Free Flaps ◽  
Fat Graft ◽  
Csf Leak ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Skull Base Reconstruction ◽  
Skull Base Defects

Abstract INTRODUCTION The most frequent complication of endoscopic endonasal surgery (EES) is postoperative cerebrospinal fluid (CSF) leak. This study was designed to develop a step-wise algorithm for EES reconstruction across the spectrum of skull base defects: from free mucosal graft for uncomplicated pituitary adenomas to free flaps in complex cases with recurrent leaks. METHODS All patients with skull base pathologies who underwent EES between January 2017 and December 2018 were included and retrospectively analyzed. Tumor location, reconstruction method and postoperative CSF leak were reviewed and a step-wise algorithm based on size and location of defect was developed. RESULTS Location of skull base defects was categorized as follows: anterior fossa, suprasellar, sellar and posterior fossa. For all nonsellar sites, we performed a multilayer (collagen matrix + /- fascia lata + /− fat graft + vascularized flap) reconstruction. The nasoseptal flap (NSF) was the first choice for vascularized reconstruction when available. For all sellar lesions we employed a free mucosal graft unless a high-flow CSF leak was present, in which case a single-layer reconstruction with NSF was performed. When the NSF was not available, alternative local (lateral nasal wall flap) and regional (extracranial pericranial flap) pedicled flaps were successful choices. When patients failed multiple attempts at repair, regional or microvascular free flaps were options. Lumbar spinal drainage was employed for large anterior and posterior fossa defects and during secondary repair of postoperative CSF leaks. Of 347 patients, 4.6% had a postoperative CSF leak. Of 158 patients with an intraoperative leak (45.5%), 10.1% developed a postoperative CSF leak: 7.8% for sellar/suprasellar defects and 13% for anterior/posterior fossa defects. CONCLUSION This algorithm provides a standardized, stepwise approach to the reconstruction of all skull base defects after EES based on location.

Use of Autologous Fat Grafts for the Endoscopic Reconstruction of Skull Base Defects: Indications, Outcomes, and Complications

2018 ◽  
Vol 32 (4) ◽  
pp. 310-317 ◽  
Author(s):  
Kent Lam ◽  
Amber U. Luong ◽  
William C. Yao ◽  
Martin J. Citardi
Keyword(s):  
Skull Base ◽  
Tertiary Care ◽  
Anterior Skull Base ◽  
Fat Graft ◽  
Skull Base Reconstruction ◽  
Autologous Fat ◽  
Fat Grafts ◽  
Autologous Fat Graft ◽  
Skull Base Defects ◽  
Csf Leaks

Background The use of abdominal free fat is a traditional surgical method for the repair and reconstruction of the anterior skull base. Our objective is to assess the outcomes associated with the autologous fat graft to endoscopically repair anterior skull base defects at a single tertiary care center. Methods All patients, who underwent endoscopic skull base repair utilizing abdominal free fat from September 2009 to June 2016, were included for retrospective chart review. Evaluated outcome measurements included (1) the successful closure of preoperative and intraoperative cerebrospinal fluid (CSF) leaks and (2) complications at both donor and recipient graft sites during the postoperative periods. Four representative clinical cases have additionally been selected to highlight the common indications for which the fat graft may be effective in skull base reconstruction. Results Of the 27 patients who were identified for inclusion in this review, 25 (92.6%) demonstrated successful repair of preoperative or intraoperative CSF leaks following primary skull base repair. Two patients developed recurrent CSF leaks occurring about 1 week after their primary closures, and a secondary closure rate of 96.3% was achieved with use of fat grafts. Other complications included seroma and hematoma formation at the abdominal donor sites, each occurring in 1 patient. Conclusions The use of autologous fat remains a viable option for grafting material during endoscopic skull base reconstruction. Despite the wide variety of closure techniques in skull base surgery, autologous fat provides safe and easily accessible material to repair CSF leaks.

Vascularised local and free flaps in anterior skull base reconstruction

2012 ◽  
Vol 270 (3) ◽  
pp. 899-907 ◽  
Author(s):  
Thomas K. Hoffmann ◽  
Nicolai El Hindy ◽  
Oliver M. Müller ◽  
Patrick J. Schuler ◽  
Christoph Bergmann ◽  
...  
Keyword(s):  
Skull Base ◽  
Free Flaps ◽  
Anterior Skull Base ◽  
Skull Base Reconstruction

scholarly journals Anterior Median Skull Base Reconstruction Using a Vascularized Free Flap: Rationale, Patient Selection and Outcome

2019 ◽  
Vol 81 (01) ◽  
pp. 030-036
Author(s):  
Omer J. Ungar ◽  
Avraham Abergel ◽  
Ahmad Safadi ◽  
Arik Zaretzki ◽  
Ravit Yanko-Arzi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
High Risk ◽  
Skull Base ◽  
Free Flap ◽  
Anterior Skull Base ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Skull Base Reconstruction ◽  
Bony Segment

Objectives To present our method of median anterior skull base (ASB) reconstruction using a subcranial approach with a free flap in cases of naso-fronto-orbital (NFO) bony segment failure and in patients at high risk for future failure of the bony frontal segment. Design This study presents as a retrospective case series. Setting Tertiary university-affiliated medical center. Participants Adult and pediatric patients who underwent median ASB resection via the subcranial approach with a free flap reconstruction were participated in this study. Main Outcome Measures Pathologic outcome and postoperative quality of life (QoL) as assessed by a validated Hebrew version of the “Anterior Skull Base Quality-of-Life Questionnaire.” Results The departmental database yielded 13 suitable patients aged between 15 and 70 years. The main indication (n = 7) for ASB surgery was osteoradionecrosis (ORN) of the NFO bony segment which was first detected at an average of 3.6 years (range: 2–32 years) postradiation therapy. High-risk patients for future ORN of the NFO segment (n = 3) were primarily reconstructed using a vascularized free flap. Nine patients had malignant disease, and four of them were alive without evidence of disease during the follow-up period (average, 48 months). Their QoL was comparable to that of patients who had undergone subcranial ASB resection without free flap reconstruction. Conclusions The ASB median free flap method of reconstruction is a safe and reliable in cases of large complex median ASB defects without orbital resection or maxillectomy. This approach is suitable for patients who had undergone previous surgery, radiotherapy and/or those who present with osteoradionecrosis, as well as for patients with high risk of NFO segment ORN.

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