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Efficacy of simultaneous pericranial and nasoseptal “double flap” reconstruction of anterior skull base defects after combined transbasal and endoscopic endonasal approaches

  • Original Article - Neurosurgical technique evaluation
  • Published:
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Abstract

Background

The “double flap” reconstruction technique, comprised of a simultaneous vascularized pedicled pericranial flap (PCF) and pedicled nasoseptal flap (NSF), can be used to repair anterior skull base defects after a combined cranionasal or transbasal-endoscopic endonasal approach (EEA) has been performed to remove malignant anterior skull base tumors. The use of two vascularized flaps may potentially decrease the incidence of post-radiation flap necrosis and postoperative cerebrospinal fluid (CSF) leaks after radiation therapy.

Methods

We conducted a retrospective review of a prospective skull base database on patients who underwent the double flap reconstruction technique after a combined transbasal-EEA approach. Data collected for each patient included demographics, method of tumor resection and repair, complications, tumor recurrence, and follow-up.

Results

Nine patients who underwent a combined transbasal-EEA approach for resection of anterior skull base tumors with significant intracranial extension followed by reconstruction of the cranial base using the double flap technique. Four were men and five were women, with a mean age of 49 years (range, 15–68 years). There was no postoperative CSF leakage detected or complications of infection, meningitis, mucocele, or tension pneumocephalus after a mean follow-up of 35.7 months (range, 4.5–98 months). Seven of the nine patients underwent adjuvant radiation without flap necrosis. Local tumor recurrence was not observed in any of the patients at last follow-up; however, one patient developed distant brain metastasis.

Conclusion

The simultaneous PCF and NSF double flap reconstruction is an effective technique in preventing postoperative CSF leakage and post-radiation necrosis when repairing anterior skull base defects after combined transbasal-EEA approaches. This technique may be useful in patients anticipated to undergo postoperative radiation therapy.

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Acknowledgments

We would like to acknowledge Chris Gralapp for the illustration demonstrating the simultaneous double flap reconstruction technique.

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Authors and Affiliations

  1. Department of Neurological Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, 90 Bergen St, Suite 8100, Newark, NJ, 07101, USA

    Phabinly J. Gabriel, Gurkirat Kohli, Jean Anderson Eloy & James K. Liu

  2. Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA

    Wayne D. Hsueh, Jean Anderson Eloy & James K. Liu

  3. Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA

    Wayne D. Hsueh, Jean Anderson Eloy & James K. Liu

  4. Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA

    Jean Anderson Eloy

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  1. Phabinly J. Gabriel
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  2. Gurkirat Kohli
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  3. Wayne D. Hsueh
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  4. Jean Anderson Eloy
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Corresponding author

Correspondence to James K. Liu.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Comments

The authors describe a nice illustration of double flap technique for reconstruction of anterior skull base in combined transbasal-endonasal endoscopic approaches with special emphases on cases in which a post-operative radiation is necessary. While I agree with the authors that this is a very good adjunct to the reconstruction of a large destructive defects of the anterior skull base, there are several important limitations including involvement of the NSF by the tumor, the inadequate length of NSF to reach the most anterior aspect of reconstruction (to achieve a long double flap extension) and the cosmetic risk of nose saddling due to the need for harvest of a very extensive NSF.

Skull base surgeons should nevertheless consider this option in their reconstruction techniques armamentarium.

Amir Dehdashti

NY, USA

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Gabriel, P.J., Kohli, G., Hsueh, W.D. et al. Efficacy of simultaneous pericranial and nasoseptal “double flap” reconstruction of anterior skull base defects after combined transbasal and endoscopic endonasal approaches. Acta Neurochir 162, 641–647 (2020). https://doi.org/10.1007/s00701-019-04155-1

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  • DOI: https://doi.org/10.1007/s00701-019-04155-1

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