Abstract
IntroductionOne of the main concerns in endoscopic endonasal approaches to the skull base has been the high incidence and morbidity associated with cerebrospinal fluid leaks. The introduction and routine use of vascularized flaps allowed a marked decrease in this complication followed by a great expansion in the indications and techniques used in endoscopic endonasal approaches, extending to defects from huge tumours and previously inaccessible areas of the skull base. ObjectiveDescribe the technique of performing endoscopic double flap multi-layered reconstruction of the anterior skull base without craniotomy. MethodsStep by step description of the endoscopic double flap technique (nasoseptal and pericranial vascularized flaps and fascia lata free graft) as used and illustrated in two patients with an olfactory groove meningioma who underwent an endoscopic approach. ResultsBoth patients achieved a gross total resection: subsequent reconstruction of the anterior skull base was performed with the nasoseptal and pericranial flaps onlay and a fascia lata free graft inlay. Both patients showed an excellent recovery, no signs of cerebrospinal fluid leak, meningitis, flap necrosis, chronic meningeal or sinonasal inflammation or cerebral herniation having developed. ConclusionThis endoscopic double flap technique we have described is a viable, versatile and safe option for anterior skull base reconstructions, decreasing the incidence of complications in endoscopic endonasal approaches.
Highlights
One of the main concerns in endoscopic endonasal approaches to the skull base has been the high incidence and morbidity associated with cerebrospinal fluid leaks
This study aims to show a novel technique for the use of the pericranial flap without a craniotomy, alongside the nasoseptal flap and a free fascia lata graft, for the correction of extensive anterior skull base defects, yielding a lower complication rate.[10,12,13]
We retrospectively reviewed the chart information of two patients with an olfactory groove meningioma diagnosis who underwent endoscopic endonasal approach for tumour resection and skull base reconstruction using the technique we will outline, using double vascularized flaps and a free fascia lata graft
Summary
One of the main concerns in endoscopic endonasal approaches to the skull base has been the high incidence and morbidity associated with cerebrospinal fluid leaks. Results: Both patients achieved a gross total resection: subsequent reconstruction of the anterior skull base was performed with the nasoseptal and pericranial flaps onlay and a fascia lata free graft inlay. Both patients showed an excellent recovery, no signs of cerebrospinal fluid leak, meningitis, flap necrosis, chronic meningeal or sinonasal inflammation or cerebral herniation having developed. Different types of vascularized flaps, nasal and extranasal, have been described for different objectives, such as facial reconstruction, orbital elevation, septal perforation corrections and, mainly, for the closure of cerebrospinal fluid (CSF) leaks during and postoperatively of the endoscopic endonasal skull base surgery, allowing for fewer techniquerelated complications and an impressive growth of this technique.1---6. It is easy to obtain and versatile, reaching from the clival region to the anterior fossa.[1,4]
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