A vascularized "superfascial" flap for middle cranial Fossa reconstruction: technical note

Area of Science:

• Neurosurgery
• Plastic Surgery
• Skull Base Surgery

Background:

• Reconstruction of the middle cranial fossa after extensive dural resection presents challenges in achieving watertight closure and preventing complications.
• Direct dural closure is often not feasible due to dural loss or intraoperative dehiscence during skull base surgery.

Purpose of the Study:

• To evaluate the efficacy of a vascularized "superfascial" flap for middle cranial fossa reconstruction when primary dural closure is not possible.
• To assess the safety and outcomes of this flap technique in patients undergoing skull base surgery.

Main Methods:

• A consecutive case series of five patients undergoing skull base surgery via a minipretemporal approach.
• Utilized a vascularized "superfascial" flap, combining periosteum, galea, and superficial temporalis fascia, to reconstruct dural defects.
• Preserved superficial temporal artery branches and minimized risk to the frontal branch of the facial nerve during flap harvesting.

Main Results:

• All five patients achieved successful reconstruction without postoperative complications such as CSF leak, infection, pseudomeningocele, or wound dehiscence.
• One patient experienced transient frontalis weakness that resolved within six weeks.
• No readmissions or return to the operating room were necessary.

Conclusions:

• The vascularized "superfascial" flap is a reliable and effective technique for middle cranial fossa reconstruction when primary closure is not achievable.
• This flap offers enhanced vascularity, broad coverage for lateral skull base defects, and good cosmetic results with minimal donor site morbidity.
• It represents a valuable alternative to conventional methods, potentially reducing wound-related complications in select skull base surgery cases.