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Outcomes of Anterior Skull Base Reconstruction

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Skull Base Reconstruction
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Abstract

Over the past two decades, techniques involved in the reconstruction of anterior skull base defects have progressed at an exponentially rapid rate. New advances in vascular tissue mobilization, image guidance technology, and advancement in minimally invasive tissue harvesting have allowed for multiple endoscopic reconstruction options of the anterior skull base. Size and location of skull base defect, experience with surgical technique, and the need for perioperative radiation therapy all play a part in the algorithm for choice of reconstructive method. Patients’ quality of life after skull base reconstruction has increased, and the nasal morbidity has decreased with progressive surgical experience. Continued efforts to expand the armamentarium of the skull base surgeon will advance the field toward better clinical outcomes and reduced complications. Here, we review the outcomes of anterior skull base reconstruction, highlight recent advances in decreasing patient morbidity, and discuss complications occurring during reconstruction.

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References

  1. Snyderman CH, Pant H, Carrau RL, Prevedello D, Gardner P, Kassam AB. What are the limits of endoscopic sinus surgery?: the expanded endonasal approach to the skull base. Keio J Med. 2009;58(3):152–60.

    Article  PubMed  Google Scholar 

  2. Patel MR, Stadler ME, Snyderman CH, et al. How to choose? Endoscopic skull base reconstructive options and limitations. Skull Base. 2010;20(6):397–404. https://doi.org/10.1055/s-0030-1253573.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Wang EW, Zanation AM, Gardner PA, et al. ICAR: endoscopic skull-base surgery. Int Forum Allergy Rhinol. 2019;9(S3):S145–s365. https://doi.org/10.1002/alr.22326.

    Article  PubMed  Google Scholar 

  4. Reyes C, Mason E, Solares CA. Panorama of reconstruction of skull base defects: from traditional open to endonasal endoscopic approaches, from free grafts to microvascular flaps. Int Arch Otorhinolaryngol. 2014;18(Suppl 2):S179–86. https://doi.org/10.1055/s-0034-1395268.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hosemann W, Goede U, Sauer M. Wound healing of mucosal autografts for frontal cerebrospinal fluid leaks–clinical and experimental investigations. Rhinology. 1999;37(3):108–12.

    CAS  PubMed  Google Scholar 

  6. Lanza DC, O'Brien DA, Kennedy DW. Endoscopic repair of cerebrospinal fluid fistulae and encephaloceles. Laryngoscope. 1996;106(9):1119–25. https://doi.org/10.1097/00005537-199609000-00015.

    Article  CAS  PubMed  Google Scholar 

  7. Banks CA, Palmer JN, Chiu AG, O'Malley BW Jr, Woodworth BA, Kennedy DW. Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years. Otolaryngol Head Neck Surg. 2009;140(6):826–33. https://doi.org/10.1016/j.otohns.2008.12.060.

    Article  PubMed  Google Scholar 

  8. Hegazy HM, Carrau RL, Snyderman CH, Kassam A, Zweig J. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea: a meta-analysis. Laryngoscope. 2000;110(7):1166–72. https://doi.org/10.1097/00005537-200007000-00019.

    Article  CAS  PubMed  Google Scholar 

  9. Liu JK, Schmidt RF, Choudhry OJ, Shukla PA, Eloy JA. Surgical nuances for nasoseptal flap reconstruction of cranial base defects with high-flow cerebrospinal fluid leaks after endoscopic skull base surgery. Neurosurg Focus. 2012;32(6):E7. https://doi.org/10.3171/2012.5.Focus1255.

    Article  PubMed  Google Scholar 

  10. Dadgostar A, Okpaleke C, Al-Asousi F, Javer A. The application of a free nasal floor mucoperiosteal graft in endoscopic sinus surgery. Am J Rhinol Allergy. 2017;31(3):196–9. https://doi.org/10.2500/ajra.2017.31.4430.

    Article  PubMed  Google Scholar 

  11. Hadad G, Bassagasteguy L, Carrau RL, et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope. 2006;116(10):1882–6. https://doi.org/10.1097/01.mlg.0000234933.37779.e4.

    Article  PubMed  Google Scholar 

  12. Pinheiro-Neto CD, Ramos HF, Peris-Celda M, et al. Study of the nasoseptal flap for endoscopic anterior cranial base reconstruction. Laryngoscope. 2011;121(12):2514–20. https://doi.org/10.1002/lary.22353.

    Article  PubMed  Google Scholar 

  13. Harvey RJ, Parmar P, Sacks R, Zanation AM. Endoscopic skull base reconstruction of large dural defects: a systematic review of published evidence. Laryngoscope. 2012;122(2):452–9. https://doi.org/10.1002/lary.22475.

    Article  PubMed  Google Scholar 

  14. Thorp BD, Sreenath SB, Ebert CS, Zanation AM. Endoscopic skull base reconstruction: a review and clinical case series of 152 vascularized flaps used for surgical skull base defects in the setting of intraoperative cerebrospinal fluid leak. Neurosurg Focus. 2014;37(4):E4. https://doi.org/10.3171/2014.7.Focus14350.

    Article  PubMed  Google Scholar 

  15. Zanation AM, Carrau RL, Snyderman CH, et al. Nasoseptal flap takedown and reuse in revision endoscopic skull base reconstruction. Laryngoscope. 2011;121(1):42–6. https://doi.org/10.1002/lary.21162.

    Article  PubMed  Google Scholar 

  16. Chabot JD, Patel CR, Hughes MA, et al. Nasoseptal flap necrosis: a rare complication of endoscopic endonasal surgery. J Neurosurg. 2018;128(5):1463–72. https://doi.org/10.3171/2017.2.Jns161582.

    Article  PubMed  Google Scholar 

  17. Choby GW, Pinheiro-Neto CD, de Almeida JR, et al. Extended inferior turbinate flap for endoscopic reconstruction of skull base defects. J Neurol Surg B Skull Base. 2014;75(4):225–30. https://doi.org/10.1055/s-0033-1358791.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Patel MR, Taylor RJ, Hackman TG, et al. Beyond the nasoseptal flap: outcomes and pearls with secondary flaps in endoscopic endonasal skull base reconstruction. Laryngoscope. 2014;124(4):846–52. https://doi.org/10.1002/lary.24319.

    Article  PubMed  Google Scholar 

  19. Lavigne P, Vega MB, Ahmed OH, Gardner PA, Snyderman CH, Wang EW. Lateral nasal wall flap for endoscopic reconstruction of the skull base: anatomical study and clinical series. Int Forum Allergy Rhinol. 2020;10(5):673–8. https://doi.org/10.1002/alr.22534.

    Article  PubMed  Google Scholar 

  20. Simal Julián JA, Miranda Lloret P, Cárdenas Ruiz-Valdepeñas E, Barges Coll J, Beltrán Giner A, Botella AC. Middle turbinate vascularized flap for skull base reconstruction after an expanded endonasal approach. Acta Neurochir. 2011;153(9):1827–32. https://doi.org/10.1007/s00701-011-1064-8.

    Article  PubMed  Google Scholar 

  21. Zanation AM, Snyderman CH, Carrau RL, Kassam AB, Gardner PA, Prevedello DM. Minimally invasive endoscopic pericranial flap: a new method for endonasal skull base reconstruction. Laryngoscope. 2009;119(1):13–8. https://doi.org/10.1002/lary.20022.

    Article  PubMed  Google Scholar 

  22. Chang BA, Ryan Hall S, Howard BE, et al. Submental flap for reconstruction of anterior skull base, orbital, and high facial defects. Am J Otolaryngol. 2019;40(2):218–23. https://doi.org/10.1016/j.amjoto.2018.11.008.

    Article  PubMed  Google Scholar 

  23. Ferrari M, Vural A, Schreiber A, et al. Side-door temporoparietal fascia flap: a novel strategy for anterior skull base reconstruction. World Neurosurg. 2019;126:e360–70. https://doi.org/10.1016/j.wneu.2019.02.056.

    Article  PubMed  Google Scholar 

  24. Fortes FS, Carrau RL, Snyderman CH, 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):970–6. https://doi.org/10.1097/MLG.0b013e3180471482.

    Article  PubMed  Google Scholar 

  25. Lim X, Rajagopal R, Silva P, Jeyaretna DS, Mykula R, Potter M. A systematic review on outcomes of anterior skull base reconstruction. J Plast Reconstr Aesthet Surg. 2020;73(11):1940–50. https://doi.org/10.1016/j.bjps.2020.05.044.

    Article  PubMed  Google Scholar 

  26. Jalisi S, O’Gara B, Toshkezi G, Chin L. Local vascularized flap reconstruction of the skull base-clinical outcomes and analysis. World Neurosurg. 2015;83(1):87–92. https://doi.org/10.1016/j.wneu.2012.11.073.

    Article  PubMed  Google Scholar 

  27. Califano J, Cordeiro PG, Disa JJ, et al. Anterior cranial base reconstruction using free tissue transfer: changing trends. Head Neck. 2003;25(2):89–96. https://doi.org/10.1002/hed.10179.

    Article  PubMed  Google Scholar 

  28. Bell EB, Cohen ER, Sargi Z, Leibowitz J. Free tissue reconstruction of the anterior skull base: a review. World J Otorhinolaryngol Head Neck Surg. 2020;6(2):132–6. https://doi.org/10.1016/j.wjorl.2020.01.004.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Riley CA, Tabaee A, Conley L, et al. Long-term sinonasal outcomes after endoscopic skull base surgery with nasoseptal flap reconstruction. Laryngoscope. 2019;129(5):1035–40. https://doi.org/10.1002/lary.27637.

    Article  PubMed  Google Scholar 

  30. Bhenswala PN, Schlosser RJ, Nguyen SA, Munawar S, Rowan NR. Sinonasal quality-of-life outcomes after endoscopic endonasal skull base surgery. Int Forum Allergy Rhinol. 2019;9(10):1105–18. https://doi.org/10.1002/alr.22398.

    Article  PubMed  Google Scholar 

  31. Bolk KG, Roth KA, Sharma A, Crosby DL. Patient-reported outcomes in sinonasal and skull base malignancy: an assessment of study quality and clinical relevance. Am J Rhinol Allergy. 2020;34(6):822–9. https://doi.org/10.1177/1945892420930967.

    Article  PubMed  Google Scholar 

  32. Little AS, Kelly D, Milligan J, et al. Prospective validation of a patient-reported nasal quality-of-life tool for endonasal skull base surgery: The Anterior Skull Base Nasal Inventory-12. J Neurosurg. 2013;119(4):1068–74. https://doi.org/10.3171/2013.3.JNS122032.

    Article  PubMed  Google Scholar 

  33. Patel ZM, DelGaudio JM. Olfaction following endoscopic skull base surgery. Curr Opin Otolaryngol Head Neck Surg. 2016;24(1):70–4. https://doi.org/10.1097/moo.0000000000000216.

    Article  PubMed  Google Scholar 

  34. Kim BY, Kang SG, Kim SW, et al. Olfactory changes after endoscopic endonasal transsphenoidal approach for skull base tumors. Laryngoscope. 2014;124(11):2470–5. https://doi.org/10.1002/lary.24674.

    Article  PubMed  Google Scholar 

  35. Rotenberg BW, Saunders S, Duggal N. Olfactory outcomes after endoscopic transsphenoidal pituitary surgery. Laryngoscope. 2011;121(8):1611–3. https://doi.org/10.1002/lary.21890.

    Article  PubMed  Google Scholar 

  36. Bedrosian JC, McCoul ED, Raithatha R, Akselrod OA, Anand VK, Schwartz TH. A prospective study of postoperative symptoms in sinonasal quality-of-life following endoscopic skull-base surgery: dissociations based on specific symptoms. Int Forum Allergy Rhinol. 2013;3(8):664–9. https://doi.org/10.1002/alr.21161.

    Article  PubMed  Google Scholar 

  37. Hart CK, Theodosopoulos PV, Zimmer LA. Olfactory changes after endoscopic pituitary tumor resection. Otolaryngol Head Neck Surg. 2010;142(1):95–7. https://doi.org/10.1016/j.otohns.2009.09.032.

    Article  PubMed  Google Scholar 

  38. Sowerby LJ, Gross M, Broad R, Wright ED. Olfactory and sinonasal outcomes in endoscopic transsphenoidal skull-base surgery. Int Forum Allergy Rhinol. 2013;3(3):217–20. https://doi.org/10.1002/alr.21103.

    Article  PubMed  Google Scholar 

  39. Kuwata F, Kikuchi M, Ishikawa M, et al. Long-term olfactory function outcomes after pituitary surgery by endoscopic endonasal transsphenoidal approach. Auris Nasus Larynx. 2020;47(2):227–32. https://doi.org/10.1016/j.anl.2019.07.002.

    Article  PubMed  Google Scholar 

  40. Li P, Luo K, Zhang Q, Wang Z. Superior turbinate management and olfactory outcome after endoscopic endonasal transsphenoidal surgery for pituitary adenoma: a propensity score-matched cohort study. Int Forum Allergy Rhinol. 2020;10(12):1276–84. https://doi.org/10.1002/alr.22694.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to James N. Palmer .

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Eide, J.G., Patel, T.D., Adappa, N.D., Palmer, J.N. (2023). Outcomes of Anterior Skull Base Reconstruction. In: Kuan, E.C., Tajudeen, B.A., Djalilian, H.R., Lin, H.W. (eds) Skull Base Reconstruction . Springer, Cham. https://doi.org/10.1007/978-3-031-27937-9_31

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  • DOI: https://doi.org/10.1007/978-3-031-27937-9_31

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