Flaps for Craniofacial Reconstruction

Abstract

Objective: Skull base reconstruction is one of the most challenging aspects of anterior skull base surgery, especially in the context of previous radiation treatment. The objective of the current study is to describe a novel strategy utilizing pericranial flap (PCF) and nasoseptal flap (NSF) closure following endoscopic-assisted craniofacial resection (EA-CFR) of sinus/skull base tumors. Method: Review of a prospectively collected database containing patients treated with combined PCF/NSF closure was performed between January 2008 and December 2011 at the University of Alabama at Birmingham. Demographics, pathology, surgical goals, location, technique, length of hospital stay, adjuvant treatments, and clinical status were assessed. Results: Four patients (average age 42.7 ± 5.2 years) had EA-CFRs utilizing the PCF/NSF reconstructive technique. Tumor histopathology included esthesioneuroblastoma (n = 2), mixed adenocarcinoma/esthesioneuroblastoma (n = 1), and sinonasal undifferentiated carcinoma (n = 1). Surgical goals were curative intent in all patients. The average length of stay following surgery was 3 days (range of 2-4). There were no postoperative CSF leaks or other complications. Three patients had received neoadjuvant chemo/radiation therapy. The NSF was utilized to cover the PCF at the junction of the planum sphenoidale and PCF in all patients. All patients have complete locoregional control with an average follow up of 26 months (17-41), although 1 patient is alive with metastases. Conclusion: Reconstruction of anterior skull base defects following EA-CFR utilizing the combined PCF/NSF technique resulted in effective closure in all patients in this series. Providing a double layer of vascularized tissue is a reasonable strategy particularly in the setting of neoadjuvant radiation treatment.