Skull Base Reconstruction Using a Temporoparietal Galeal Flap in Simultaneous Transnasal and Transcranial Surgery for the Prevention of Carotid Blowout Syndrome: A Report of 3 Cases

Kenichiro Iwami; Masazumi Fujii; Shinya Jinguji; Yugo Kishida; Tadashi Watanabe; Koji Oosuka; Kiyoshi Saito

doi:10.1055/s-0039-3402035

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2021; 82(S 03): e236-e242
DOI: 10.1055/s-0039-3402035

Original Article

Skull Base Reconstruction Using a Temporoparietal Galeal Flap in Simultaneous Transnasal and Transcranial Surgery for the Prevention of Carotid Blowout Syndrome: A Report of 3 Cases

Authors

Kenichiro Iwami

¹Department of Neurosurgery, Aichi Medical University, Aichi, Japan
Masazumi Fujii

²Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan
Shinya Jinguji

³Department of Neurosurgery, Toyama Prefectural Central Hospital, Toyama, Japan
Yugo Kishida

⁴Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
Tadashi Watanabe

¹Department of Neurosurgery, Aichi Medical University, Aichi, Japan
Koji Oosuka

¹Department of Neurosurgery, Aichi Medical University, Aichi, Japan
Kiyoshi Saito

²Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan

Abstract

Background Carotid blowout syndrome (CBS) is a rare complication that usually occurs after removal of head and neck tumors. Since transnasal skull base surgery allows a wide exposure of the ventral skull base, neurosurgeons should pay attention to prevent this devastating complication. We present, three cases involving exposure of the internal carotid artery (ICA) at the skull base during the simultaneous transnasal and transcranial approach.

Case Description The first patient was a 69-year-old man with a recurrent chordoma. The exposed ICA was covered by an abdominal fat graft and nasoseptal flap, but he experienced CBS 2 months later and died. The second patient was a 66-year-old man with an intraosseous cavernous angioma of the petrous bone. The exposed ICA was covered by a temporoparietal galeal flap (TPGF), abdominal fat graft, and nasoseptal flap. The third patient was a 73-year-old man with skull base radiation necrosis and intracerebral abscess after proton beam therapy for orbital adenoid cystic carcinoma. The exposed ICA was covered by TPGF. The second and third patients' postoperative courses were uneventful.

Conclusion Based on our experience, a nasoseptal flap alone may be insufficient to protect ICA. TPGF is therefore another available reconstruction option that may help prevent CBS.

Keywords

carotid blowout syndrome - internal carotid artery - skull base reconstruction - temporoparietal galeal flap

Full Text

References

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