Double Flap Technique for Reconstruction of Anterior Skull Base Defects after Craniofacial Tumor Resection

Abstract

Background: Successful reconstruction of large anterior skull base (ASB) defects after craniofacial resection of malignant skull base tumors is paramount for preventing cerebrospinal fluid (CSF) fistulas. The vascularized pedicled pericranial flap has been the gold standard for repair. However, flap necrosis and delayed CSF leaks can occur after adjuvant radiation therapy. We describe a double flap repair, where the pericranial flap is augmented inferiorly by a secondary vascularized nasoseptal flap (NSF) that is harvested and rotated using an endonasal endoscopic approach. This technique is illustrated in two patients who underwent resection of large sinonasal/anterior skull base malignancies with significant intracranial extension.