Repair of Anterior Skull Base Defect by Dual-Layer/Split-Frontal Pericranial Flap

Area of Science:

• Neurosurgery
• Otolaryngology
• Skull Base Surgery

Background:

• Skull base defects can result from pathology or surgery, leading to cerebrospinal fluid (CSF) leaks.
• Transnasal repair using nasal septal flaps is common, but may fail in complex cases.
• Alternative repair methods are needed when standard approaches are insufficient.

Observation:

• A 74-year-old man with persistent CSF leak and ventriculitis after multiple transnasal surgeries for pituitary macroadenoma was treated.
• A cranionasal approach utilizing a dual layer/split frontal pericranial flap (PF) was employed.
• The PF was divided, with one part placed intradurally and the other transnasally to cover the defect.

Findings:

• The cranionasal dual layer/split PF technique successfully repaired the extensive skull base defect.
• Cerebrospinal fluid leak was halted, and ventriculitis was resolved with antibiotic treatment.
• This technique provided a successful outcome in a patient with a history of multiple failed repairs.

Implications:

• The cranionasal dual layer/split PF technique is a valuable option for complex anterior skull base defects and CSF leaks.
• This method is particularly useful when conventional transnasal repairs have failed or are not feasible.
• It offers a high chance of success in challenging skull base reconstruction scenarios.