J Neurol Surg B Skull Base 2018; 79(S 01): S1-S188
DOI: 10.1055/s-0038-1633730
Poster Presentations
Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Double Flap Technique for Reconstruction of Large Anterior Skull Base Defects: Technical Note

Ricardo Dolci
1   Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
,
Alexandre B. Todeschini
2   The Ohio State University, Columbus, Ohio, United States
,
Américo Dos Santos
1   Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
,
Paulo Lazarini
1   Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
› Author Affiliations
Further Information

Publication History

Publication Date:
02 February 2018 (online)

 

Background One of the main concerns in endoscopic endonasal approaches (EEAs) to the skull base has been the high incidence and morbidity associated with cerebrospinal fluid (CSF) leaks. The introduction and routine use of vascularized flaps caused a marked decrease in this complication followed by a great expansion in the indications and techniques used in EEA, extending to bigger tumors and previously inaccessible areas of the skull base.

Objective To describe the technique for endoscopic double flap multilayered reconstruction of the anterior skull base without the need for a craniotomy.

Methods The endoscopic double flap technique combines the use of the nasoseptal and pericranial vascularized flaps. Initially, a free fascia lata graft was harvested from the right thigh and placed inlay at the skull base opening. Then, the pericranial flap, coming from the frontal sinus was placed onlay over the anterior fossa, from the posterior wall of the frontal sinus heading posteriorly, and the nasoseptal flap was placed over the sphenoid moving anteriorly over the defect and the pericranial flap. That way, a multilayered reconstruction was achieved with a double vascularized flap over the defect, with each flap being reinforced by the other at its free margin. We illustrate this technique as used in two patients with an olfactory groove meningioma who underwent surgery via an EEA.

Results Both patients achieved a gross total resection and subsequent reconstruction of the anterior skull base was done with the nasoseptal and pericranial flaps onlay and a fascia lata free graft inlay. Both patients showed an excellent recovery with no signs of CSF leak, meningitis, flap necrosis, chronic meningeal or sinonasal inflammation, or cerebral herniation.

Conclusion This endoscopic double flap technique as we have described is a viable, versatile, and safe option for anterior skull base reconstructions, decreasing the incidence of CSF in EEA.