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How I do it: epidural transposition of the temporoparietal fascia flap for anterior skull base reconstruction

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Abstract

Background

Multilayer closures and the use of vascularized flaps have been showed to be very effective in the reconstruction of the anterior skull base (ASB) after extended endonasal approaches resulting in large bone and dural defects. In the case of unavailability of a local flap, regional ones like the temporoparietal fascia flap (TPFF), used until now via a transpterygoïd route (Bolzoni Villaret et al. in Eur Arch Otorhinolaryngol 270(4):1473–1479, 2023; Fortes et al. in Laryngoscope 117(6):970–976, 2017; Veyrat et al. in Acta Neurochir (Wien) 158(12):2291–2294, 2016), can be an effective alternative.

Method

We describe a step-by-step technique of TPFF transposition via an epidural supraorbital corridor for the reconstruction of a large midline ASB defect.

Conclusion

TPFF is a promising alternative for the reconstruction of the ASB defects.

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Abbreviations

TPFF:

Temporoparietal fascia flap

STA:

Superficial temporal artery

EEA:

Endoscopic endonasal approach

ASB:

Anterior skull base

CSF:

Cerebrospinal fluid

CTA:

Computed tomography angiography

References

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Author information

Authors and Affiliations

  1. Neurosurgery Department, AP-HP, Henri Mondor University Hospital, 51 avenue du Marechal de Lattre de Tassigny, 94000, Créteil, France

    Tania Idriceanu & Benoit Hudelist

  2. ENT Department, Gustave Roussy Cancer Campus, 94800, Villejuif, France

    Antoine Moya-Plana

  3. Neurosurgery Department, Foch University Hospital, 92150, Suresnes, France

    Damien Bresson

Authors
  1. Tania Idriceanu
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  2. Benoit Hudelist
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  3. Antoine Moya-Plana
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  4. Damien Bresson
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Corresponding author

Correspondence to Tania Idriceanu.

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This article does not contain any studies with human participants performed by any of the authors.

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The authors declare no competing interests.

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Key points

1. Selected indications only for the use of the TPPF in the reconstruction of the ASB due to the fact that this procedure adds extra morbidity by requiring a large skin incision and a bone flap.

2. Computer tomography angiography is mandatory to assess the anatomy of the STA.

3. STA anatomy dictates the donor side.

4. A flap with a length of 17 cm is sufficient to achieve most reconstructions.

5. The flap should be wider at the distal end to surpass the area of the bone defect.

6. Avoid excessive tension of the pedicle when pulling the flap from the nose during reconstruction.

7. Flap viability check with Doppler at the end of surgery.

8. Special consideration when transposing the flap to avoid the twist of the pedicle.

9. Nasal wash with a saline solution is advisable for at least 4 to 6 weeks.

10. Regular endoscopic look to assess the healing process.

Supplementary informattion

ESM 1

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Idriceanu, T., Hudelist, B., Moya-Plana, A. et al. How I do it: epidural transposition of the temporoparietal fascia flap for anterior skull base reconstruction. Acta Neurochir 165, 2327–2331 (2023). https://doi.org/10.1007/s00701-023-05602-w

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  • DOI: https://doi.org/10.1007/s00701-023-05602-w

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