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. 2010 Nov;20(6):397-404.
doi: 10.1055/s-0030-1253573.

How to choose? Endoscopic skull base reconstructive options and limitations

Mihir R Patel, Michael E Stadler, Carl H Snyderman, Ricardo L Carrau, Amin B Kassam, Anand V Germanwala, Paul Gardner, Adam M Zanation

How to choose? Endoscopic skull base reconstructive options and limitations

Mihir R Patel et al. Skull Base. 2010 Nov.

Abstract

As endoscopic skull base resections have advanced, appropriate reconstruction has become paramount. The reconstructive options for the skull base include both avascular and vascular grafts. We review these and provide an algorithm for endoscopic skull base reconstruction. One hundred and sixty-six skull base dural defects, reconstructed with an endonasal vascular flap, were examined. As an adjunct, avascular reconstruction techniques are discussed to illustrate all options for endonasal skull base reconstruction. Cerebrospinal fluid (CSF) leak rates are also discussed. Small CSF leaks may be successfully repaired with various avascular grafting techniques. Endoscopic endonasal approaches (EEAs) to the skull base often have larger dural defects with high-flow CSF leaks. Success rates for some EEA procedures utilizing avascular grafts approach 90%, yet in high-flow leak situations, success rates are much lower (50 to 70%). Defect location and complexity guides vascularized flap choice. When nasoseptal flaps are unavailable, anterior/sellar defects are best managed with an endoscopically harvested pericranial flap, whereas clival/posterior defects may be reconstructed with an inferior turbinate or temporoparietal flap. An endonasal skull base reconstruction algorithm was constructed and points to increased use of various vascularized reconstructions for more complex skull base defects.

Keywords: AlloDerm; CSF leak rate; Skull base reconstruction; algorithm; nasoseptal flap; pericranial flap; skull base; vascular reconstruction.

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Figures

Figure 1
Figure 1
Algorithm for endoscopic skull base reconstruction.
Figure 2
Figure 2
Skull base reconstruction algorithm for high-flow intraoperative CSF leaks. ITF, inferior turbinate flap; MTF, middle turbinate flap; NSF, nasoseptal flap; PLF, pericranial flap; PF, palatal flap; TPFF, temporoparietal fascia flap.
See this image and copyright information in PMC

References

    1. Hegazy H M, Carrau R L, Snyderman C H, Kassam A, Zweig J. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea: a meta-analysis. Laryngoscope. 2000;110(7):1166–1172. - PubMed
    1. Senior B A, Jafri K, Benninger M. Safety and efficacy of endoscopic repair of CSF leaks and encephaloceles: a survey of the members of the American Rhinologic Society. Am J Rhinol. 2001;15(1):21–25. - PubMed
    1. Kassam A, Thomas A J, Snyderman C, et al. Fully endoscopic expanded endonasal approach treating skull base lesions in pediatric patients. J Neurosurg. 2007;106(2, Suppl):75–86. - PubMed
    1. Zanation A M, Snyderman C H, Carrau R L, Kassam A B, Gardner P A, Prevedello D M. Minimally invasive endoscopic pericranial flap: a new method for endonasal skull base reconstruction. Laryngoscope. 2009;119(1):13–18. - PubMed
    1. Fortes F S, Carrau R L, Snyderman C H, et al. Transpterygoid transposition of a temporoparietal fascia flap: a new method for skull base reconstruction after endoscopic expanded endonasal approaches. Laryngoscope. 2007;117(6):970–976. - PubMed