Abstract
Background
Reconstruction of clival defects may be challenging in expanded endonasal skull base
surgery. We conducted a systematic review to evaluate the outcomes of vascularized
flaps used for clival reconstruction.
Methodology
The following databases were searched using a combination of Medical Subject Headings
(MeSH) and keywords related to clival reconstruction in July 2024: Ovid Medline, Ovid
Embase, Scopus, and Web of Science. Studies reporting outcomes of clival reconstruction
with vascularized free and pedicled flaps in patients were selected for complete review.
Results
Twenty-three studies were included for detailed study. Clival reconstruction with
free flaps was done in 18 patients; 17 had a successful repair, outcome was not reported
for 1. Facial vessels were preferred for microvascular anastomosis. Radial artery
forearm flap and anterolateral thigh flap were most utilized. Pedicled flaps were
used in 68 patients, with reported success in 85.3%. Nasoseptal flap was the most
common intranasal flap, used in 34 patients with successful reconstruction in 85.3%.
Temporoparietal fascia flap was the most common extranasal flap, successfully used
in 13 patients. Intranasal pedicled flaps, wherever available, were preferably used
for primary reconstruction; extranasal flaps were the next choice. Free flaps were
reserved for salvage reconstruction due to prior failed or unavailable local pedicled
flaps.
Conclusion
Satisfactory reconstructive outcomes are reported using pedicled and free flaps. The
flap of choice is determined by the previous surgical history, radiotherapy, wound
vascularity, defect size, overall health of the surrounding nasal mucosa, simultaneous
clival surgery, and the preferred pedicle transposition route (free flaps).
Keywords
clival reconstruction - free flap - pedicled flap - nasopharyngeal tumor - osteoradionecrosis
