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Reconstruction of Clival Defects using Vascularized Free and Pedicled Flaps: Systematic Review and Proposed
Nitish Kumar1, Brent A Chang1, Michael J Marino1
1Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona.
Journal of Neurological Surgery. Part B, Skull Base
|March 11, 2026
Summary
Vascularized flaps, including pedicled and free flaps, offer successful clival reconstruction in skull base surgery. The choice of flap depends on patient factors and defect characteristics.
Area of Science:
- Neurosurgery
- Otolaryngology
- Plastic Surgery
Background:
- Clival defect reconstruction presents significant challenges in expanded endonasal skull base surgery.
- Vascularized flaps are crucial for successful clival repair.
Purpose of the Study:
- To systematically review the outcomes of vascularized flaps utilized for clival reconstruction.
- To identify factors influencing flap selection in skull base surgery.
Main Methods:
- A systematic review of four databases (Ovid Medline, Embase, Scopus, Web of Science) was conducted in July 2024.
- Studies reporting outcomes of vascularized free and pedicled flaps for clival reconstruction were selected.
Main Results:
- Twenty-three studies involving 86 patients were analyzed.
- Pedicled flaps (nasoseptal, temporoparietal fascia) showed high success rates (85.3%).
- Free flaps (radial artery forearm, anterolateral thigh) were primarily used for salvage reconstruction with a high success rate (17/18 patients).
Conclusions:
- Both pedicled and free vascularized flaps provide satisfactory outcomes for clival reconstruction.
- Flap selection is guided by patient history, defect specifics, and surgical approach.
