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How I do it. The pedicled temporoparietal fascia flap for skull base reconstruction after endonasal endoscopic approaches

  • How I Do it - Neurosurgical Techniques
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Abstract

Background

Endoscopic endonasal approaches (EEA) are an alternative for removing challenging nasopharyngeal or skull base lesions. In some cases, a nasoseptal flap (NSF) is not always available and such complex procedures may lead to carotid arteries exposition and/or dura mater (DM) wide opening. Meticulous carotid coverage and DM reconstruction are crucial for preventing early and delayed complications.

Method

We propose a step-by-step description of the pedicled temporoparietal fascia flap (TPFF) technique, with a focus on its pitfalls, advantages and limits.

Conclusion

The TPFF is a reliable flap for skull base reconstruction when other pedicled flaps are not available.

Key points

1. Reliable flap even for irradiated patients

2. CT angiography with 3D reconstruction as pre-operative imaging

3. Doppler ultrasound probe to draw the artery’s trajectory on skin

4. TPFF elevation concomitantly to the endoscopic procedure

5. Hemicoronal incision sufficient to harvest the TPFF

6. Superficial dissection in a plane just beneath the hair follicles

7. Dissection plane deep to the fad pad to preserve the frontal branch of the facial nerve

8. Surgical corridor wide enough to avoid any compression of the pedicle

9. Double visualization to avoid any twist and Doppler control of the STA patency

10. Close follow-up, toilet in clinics

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References

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Author information

Authors and Affiliations

  1. Department of Head and Neck Surgery, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris-Diderot, Sorbonne Paris-Cité, Hôpital Lariboisière; 2, rue Ambroise Paré, 75010, Paris, France

    Mathieu Veyrat, Benjamin Verillaud & Philippe Herman

  2. Department of Neurosurgery, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France

    Damien Bresson

Authors
  1. Mathieu Veyrat
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  2. Benjamin Verillaud
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  3. Philippe Herman
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  4. Damien Bresson
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Corresponding author

Correspondence to Damien Bresson.

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No sponsorships or competing interests have been disclosed for this article.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Step by step TPFF technique: coverage of a “type 3” rhinopharyngectomy performed for a recurrent nasopharyngeal carcinoma (left side) in a 25-year-old woman. (MOV 324810 kb)

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Veyrat, M., Verillaud, B., Herman, P. et al. How I do it. The pedicled temporoparietal fascia flap for skull base reconstruction after endonasal endoscopic approaches. Acta Neurochir 158, 2291–2294 (2016). https://doi.org/10.1007/s00701-016-2969-z

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  • DOI: https://doi.org/10.1007/s00701-016-2969-z

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