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Published on: August 1, 2022
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Anterior Skull Base Reconstruction in Multiportal Approaches: Insight into Vascularized Flap Techniques.
Luca Ferlendis1, Bianca Bossi1, Antonio Tabano1
1Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Luigi Borri, 57, 21100 Varese, Italy.
Journal of Clinical Medicine
|December 17, 2024
Summary
A pericranial flap (PF) alone is effective for anterior skull base reconstruction after endoscopic surgery, minimizing cerebrospinal fluid (CSF) leaks. Adding a nasoseptal flap (NSF) offers benefits in specific complex cases.
Area of Science:
- Neurosurgery
- Otolaryngology
- Skull Base Surgery
Background:
- Anterior skull base (ASB) reconstruction is crucial after cranio-endoscopic approaches (CEA).
- Evaluating single versus double vascularized flap techniques is essential for optimizing outcomes.
- A 12-year experience provides a robust dataset for analysis.
Purpose of the Study:
- To compare the outcomes of single (pericranial flap - PF) versus double (PF + nasoseptal flap - NSF) vascularized flap techniques for ASB reconstruction post-CEA.
- To assess the incidence of cerebrospinal fluid (CSF) leakage and the impact of adjuvant radiotherapy (RT).
Main Methods:
- Retrospective analysis of 46 patients undergoing ASB reconstruction after CEA (2010-2022).
- Group 1: Single flap (PF + fascia graft).
- Group 2: Double flap (PF + fascia graft + NSF).
Main Results:
- Single PF technique (Group 1) showed no significant postoperative CSF leaks, demonstrating effectiveness in ASB defect repair.
- Dual flap approach (Group 2) yielded similar outcomes, proving beneficial for post-traumatic fistulas or specific tumor involvements.
- No significant differences in complications or flap necrosis were observed between groups, even with adjuvant RT.
Conclusions:
- The pericranial flap (PF) is a reliable single-flap option for ASB reconstruction, especially with multilayer techniques.
- The nasoseptal flap (NSF) addition is advantageous in select cases like post-traumatic defects or extensive tumors.
- Tailored surgical strategies focusing on PF with multilayer reconstruction minimize CSF leakage and flap necrosis.
