Posterior Pedicle Lateral Nasal Wall Flap: A New Reconstructive Technique for Large Defects of the Skull Base

2011 ◽  
Vol 121 (S5) ◽  
pp. S354-S354
Author(s):  
Carlos M Rivera-Serrano ◽  
Luis Bassagaisteguy ◽  
Gustavo Hadad ◽  
Ricardo Carrau ◽  
Dan Kelly ◽  
...  
Keyword(s):  
Skull Base ◽  
Lateral Nasal Wall ◽  
Reconstructive Technique

Posterior Pedicle Lateral Nasal Wall Flap: A New Reconstructive Technique for Large Defects of the Skull Base

2012 ◽  
Vol 73 (S 01) ◽  
Author(s):  
G. Hadad ◽  
C. Rivera-Serrano ◽  
L. Bassagaisteguy ◽  
R. L. Carrau ◽  
J. Fernandez-Miranda ◽  
...  
Keyword(s):  
Skull Base ◽  
Lateral Nasal Wall ◽  
Reconstructive Technique

The Nasoseptal Chondromucosal Flap: A Rigid Reconstructive Technique for Skull Base and Orbital Defects

ORL ◽  
2020 ◽  
Vol 82 (5) ◽  
pp. 268-273
Author(s):  
Daniel B. Spielman ◽  
Matthew Kim ◽  
Jonathan Overdevest ◽  
David A. Gudis
Keyword(s):  
Skull Base ◽  
Reconstructive Technique ◽  
Orbital Defects

Anterior Pedicle Lateral Nasal Wall Flap: A Novel Technique for the Reconstruction of Anterior Skull Base Defects

2011 ◽  
Vol 121 (S5) ◽  
pp. S355-S355
Author(s):  
Gustavo Hadad ◽  
Carlos M Rivera-Serrano ◽  
Luis Bassagaisteguy ◽  
Ricardo Carrau ◽  
Daniel Prevedello ◽  
...  
Keyword(s):  
Skull Base ◽  
Anterior Skull Base ◽  
Lateral Nasal Wall ◽  
Novel Technique ◽  
Skull Base Defects

Various modifications of a vascularized nasoseptal flap for repair of extensive skull base dural defects

2020 ◽  
Vol 132 (2) ◽  
pp. 371-379 ◽  
Author(s):  
Ju Hyung Moon ◽  
Eui Hyun Kim ◽  
Sun Ho Kim
Keyword(s):  
Skull Base ◽  
Inferior Turbinate ◽  
Lateral Nasal Wall ◽  
Dural Defect ◽  
Nasoseptal Flap ◽  
Endonasal Surgery ◽  
Csf Rhinorrhea ◽  
Nasal Floor ◽  
Dural Defects ◽  
Skull Base Defects

OBJECTIVEEndonasal surgery of the skull base requires watertight reconstruction of the skull base that can seal the dural defect to prevent postoperative CSF rhinorrhea and consequent intracranial complications. Although the incidence of CSF leakage has decreased significantly since the introduction in 2006 of the vascularized nasoseptal flap (the Hadad-Bassagasteguy flap), reconstruction of extensive skull base dural defects remains challenging. The authors describe a new, modified vascularized nasoseptal flap for reconstruction of extensive skull base dural defects.METHODSA retrospective review was conducted on 39 cases from 2010 to 2017 that involved reconstruction of the skull base with an endonasal vascularized flap. Extended nasoseptal flaps were generated by adding the nasal floor and inferior meatus mucosa, inferior turbinate mucosa, or entire lateral nasal wall mucosa. The authors specifically highlight the surgical techniques for flap design and harvesting of these various modifications of the vascularized nasoseptal flap.RESULTSThirty-nine endonasal vascularized flaps were used to reconstruct skull base defects in 37 patients with nonsurgical or postoperative CSF rhinorrhea. Of the 39 procedures, extended nasoseptal flaps were used in 5 cases (13%). These included 2 extended nasoseptal flaps including the inferior turbinate mucosa and 3 extended nasoseptal flaps including the entire lateral nasal wall mucosa. These 5 extended nasoseptal flaps were used in patients who had nonsurgical CSF rhinorrhea due to extensive skull base destruction by invasive pituitary tumors. All flaps healed completely and sealed off the CSF leaks. Olfactory function slightly decreased in the 3 patients with extended nasoseptal flaps including the entire lateral nasal wall mucosa. One patient experienced nasolacrimal duct obstruction, which was treated by dacryocystorhinostomy. The authors encountered no wound complication in this series, while crusting at the donor site required daily nasal toilette and frequent debridement until the completion of mucosalization, which usually takes 8 to 12 weeks after surgery.CONCLUSIONSExtended nasoseptal flaps are a reliable and versatile option that can be used to reconstruct extensive skull base dural defects resulting from destruction by large invasive tumors or complex endoscopic endonasal surgery. An extended nasoseptal flap that includes the entire lateral nasal wall mucosa (360° flap) is the largest endonasal vascularized flap reported to date and may be an alternative for the reconstruction of extensive skull base defects while avoiding the need for additional external approaches.

Nasoseptal Flap Reconstruction of High Flow Intraoperative Cerebral Spinal Fluid Leaks during Endoscopic Skull Base Surgery

2009 ◽  
Vol 23 (5) ◽  
pp. 518-521 ◽  
Author(s):  
Adam M. Zanation ◽  
Ricardo L. Carrau ◽  
Carl H. Snyderman ◽  
Anand V. Germanwala ◽  
Paul A. Gardner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radiation Therapy ◽  
Skull Base ◽  
Cerebral Spinal Fluid ◽  
High Flow ◽  
Spinal Fluid ◽  
Csf Leak ◽  
Flap Reconstruction ◽  
Nasoseptal Flap ◽  
Reconstructive Technique

Background Over the past 10 years, significant anatomic, technical, and instrumentation advances have facilitated the exposure and resection of intradural lesions via a fully endoscopic expanded endonasal approach (EEA). The vascularized nasoseptal flap (based on the posterior nasoseptal artery) has become our primary endoscopic reconstructive technique. The goals of this study are to prospectively evaluate the nasoseptal flap and high-risk cerebral spinal fluid (CSF) leak variables. Methods Prospective evaluation was performed of EEA patients with intraoperative high-flow leaks (either a cistern or ventricle open to nasal cavity during tumor dissection) who underwent nasoseptal flap reconstruction. Results Seventy consecutive nasoseptal flaps for high-flow intraoperative leaks were evaluated prospectively by the primary author. Twelve risk factors were then graded at the time of the operations and correlated to CSF leak outcomes. The overall postoperative CSF leak rate was 5.7% (4/70). All four postoperative leaks were successfully managed with endoscopic repair and CSF diversion. A multivariate analysis of all 12 risk factors is detailed. Pediatric patients, large dural defects, and radiation therapy were noted to be factors in reconstructive failure. One flap death occurred in a patient with prior surgery and proton therapy, this leak was managed with a temporoparietal flap and endonasal repair. Conclusion The nasoseptal flap is an excellent anterior skull base reconstructive technique. Patients with high-flow intraoperative CSF leaks had a 94% successful reconstruction rate. Patients with skull base proton radiation therapy are at higher risk for flap failure and preparation for nonradiated tissue reconstruction should be discussed with the patient.

Anterior Pedicle Lateral Nasal Wall Flap: A Novel Technique for the Reconstruction of Anterior Skull Base Defects

2012 ◽  
Vol 73 (S 01) ◽  
Author(s):  
G. Hadad ◽  
C. Rivera-Serrano ◽  
L. Bassagasteguy ◽  
R. L. Carrau ◽  
D. M. Prevedello ◽  
...  
Keyword(s):  
Skull Base ◽  
Anterior Skull Base ◽  
Lateral Nasal Wall ◽  
Novel Technique ◽  
Skull Base Defects

scholarly journals Transorbital Endoscopic Identification of Supernumerary Ethmoid Arteries

2016 ◽  
Vol 7 (3) ◽  
pp. ar.2016.7.0167 ◽  
Author(s):  
Angelique M. Berens ◽  
Greg E. Davis ◽  
Kris S. Moe
Keyword(s):  
Optic Nerve ◽  
Skull Base ◽  
Endoscopic Sinus Surgery ◽  
Average Distance ◽  
Total Sample ◽  
Sinus Surgery ◽  
Lateral Nasal Wall ◽  
Orbital Wall ◽  
Medial Orbital Wall ◽  
Anterior Lacrimal Crest

Background Anterior and posterior ethmoid arteries supply the paranasal sinuses, septum, and lateral nasal wall. Precise identification of these arteries is important during anterior skull base procedures, endoscopic sinus surgery, and ligation of ethmoid arteries for epistaxis refractory to standard treatment. There is controversy in the literature regarding the prevalence of supernumerary ethmoid arteries. Objective This study examined the prevalence of supernumerary ethmoid arteries by using direct visualization after transorbital endoscopic dissection. Methods Nineteen cadaveric specimens were evaluated by using a superior lid crease (blepharoplasty) incision and an endoscopic approach to the medial orbital wall. Ethmoid arteries were identified as they pierced the lamina papyracea coplanar with the skull base and optic nerve. The distances from the anterior lacrimal crest to the ethmoid arteries and optic nerve were measured with a surgical ruler under endoscopic guidance. Results Thirty-eight cadaveric orbits were measured. Overall, there were three or more ethmoid arteries (including anterior and posterior arteries) in 58% of orbits, with 8% of the total sample that contained four or more ethmoid arteries. The average number of ethmoid arteries was 2.7. Bilateral supernumerary ethmoid arteries were noted in 42% of the specimens. The distance between the anterior lacrimal crest and the anterior ethmoid, posterior ethmoid, and optic nerve averaged 20, 35, and 41 mm, respectively. The average distance to the supernumerary or middle ethmoid artery was 29 mm. Conclusion This study found supernumerary ethmoid arteries in 58% of cadaveric specimens, a prevalence much higher than previously reported. Recognition of these additional vessels may improve safety during endoscopic sinus surgery and skull base surgery, and may permit more effective ligation for refractory epistaxis originating from the ethmoid system.

scholarly journals Evolution and Innovation of reconstructive technique in endoscopic endonasal skull base surgery

2021 ◽  
Vol 1 ◽  
pp. 100597
Author(s):  
I. Bove ◽  
D. Solari ◽  
F. Esposito ◽  
P. Cappabianca ◽  
L.M. Cavallo
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Endoscopic Endonasal ◽  
Reconstructive Technique

scholarly journals Preservation of olfactory function following endoscopic resection of select malignancies of the nasal vault

2012 ◽  
Vol 2 (1) ◽  
pp. 5 ◽  
Author(s):  
Yew Kwang Ong ◽  
C. Arturo Solares ◽  
Ricardo L. Carrau ◽  
Daniel M. Prevedello ◽  
Amin B. Kassam
Keyword(s):  
Skull Base ◽  
Endoscopic Resection ◽  
Tumor Resection ◽  
Case Series ◽  
Anterior Skull Base ◽  
Olfactory Function ◽  
Lateral Nasal Wall ◽  
Retrospective Case ◽  
Case Series Study

Preservation of olfactory function during anterior skull base surgery has been previously described. However, its feasibility during oncological resection remains undefined. The aim of this study was to clarify the feasibility of preserving olfactory function in select patients undergoing oncological anterior skull base resection via endonasal endoscopic approach. This is a retrospective case series study. Postoperatively, all patients underwent a standardized smell identification test (Sensonics Inc., Haddon, NJ, USA). From January 2002 to December 2009, we attempted to preserve olfactory function in 9 patients who required an endoscopic resection involving the anterior skull base for treatment of various malignancies presenting unilateral extension. These included: esthesioneuroblastoma (n=6), squamous cell carcinoma (n=1), adenocarcinoma (n=1) and hemangiopericytoma (n=1). In 7 patients, resection included a unilateral endoscopic craniectomy with preservation of the contralateral middle and superior turbinates. Two patients underwent resection of the entire lateral nasal wall and the olfactory epithelium as the superior limit of tumor resection. Six patients received adjuvant radiotherapy. Postoperatively, olfaction was documented in 7 patients (3 normosmic, 4 microsmic). All patients are free of recurrence at the original site at a mean follow-up period of 55.7 months (range 21-101 months). One patient with an esthesioneuroblastoma developed a cervical lymph node recurrence four years after surgery. In selected cases, it is feasible to preserve olfactory function without apparent compromise of oncological outcomes. The success rate depends largely on the extent of the resection, which, in turn, is dictated, by the extent of the tumor.

scholarly journals Radial Forearm Free Tissue Transfer to Clival Defect

2019 ◽  
Vol 80 (S 04) ◽  
pp. S380-S381 ◽  
Author(s):  
Jennifer D. Moy ◽  
Paul A. Gardner ◽  
Shaum Sridharan ◽  
Eric W. Wang
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Free Tissue Transfer ◽  
Proton Beam Therapy ◽  
Craniocervical Junction ◽  
Csf Leak ◽  
Lateral Nasal Wall ◽  
Endoscopic Endonasal ◽  
Clival Chordoma ◽  
Radial Forearm

Abstract Introduction Reconstruction of craniocervical junction (CCJ) defects after endoscopic endonasal skull base surgery (ESBS) remains challenging, despite advancements in vascularized intranasal and regional flaps. Microvascular free tissue transfers have revolutionized reconstruction in open skull base surgery but have been utilized rarely in ESBS. We describe the use of a radial forearm free flap (RFFF) for reconstruction of a recalcitrant CCJ defect after resection of a clival chordoma. Case Report A 54-year-old female who underwent ESBS for a clival chordoma complicated by a C1–C2 epidural abscess after proton beam therapy presented with pneumocephalus 4 years after her resection (Fig. 1). At the CCJ, she developed a 1-cm skull-base defect. An occult cerebrospinal fluid (CSF) leak persisted despite an extracranial pericranial flap and a lateral nasal wall flap. Her definite reconstruction was a RFFF inset through a transmaxillary approach. Using a maxillary vestibular incision, anterior, lateral, and medial maxillotomies allowed the introduction of the flap into the nasal cavity and the passage of the RFFF pedicle across the posterior maxillary wall, into the premassateric space and to the facial vessels at the mandible. An endonasal inset supplemented with transoral suturing of the distal end of the flap to the posterior oropharynx halted further CSF egress. Vascularization of the flap was confirmed with intraoperative indocyanine green angiography and postoperative computed tomography (CT) angiography and magnetic resonance imaging (MRI). Conclusion A RFFF inset through a transmaxillary approach to the facial vessels has an adequate reconstructive surface and pedicle to cover the central and posterior fossa skull base after ESBS (Fig. 2).The link to the video can be found at: https://youtu.be/rQ5vJKyD5qg.

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