“Inverted Gull Wing” Dural Closure and Middle Fossa Floor Reconstruction After Transzygomatic Infratemporal Fossa Approach

Abstract

Ineffective closure of complex skull base approaches leads to wound complications and cerebrospinal fluid (CSF) leak. This can result in protracted hospital stays, additional procedures, delayed postoperative recovery, and increased cost of care. Removal of large middle fossa-infratemporal fossa tumors are particularly problematic as they result in a large dead space with gravity-facilitated CSF leakage into the cavity. In this report we describe the use of a novel technique, the "inverted gull wing" titanium mesh reconstruction. Attempts to address this problem have focused primarily on closure and the use of myocutaneous flaps. Patients who have had multiple prior treatments are often afflicted with significant tissue attenuation that preclude dural closure or the use of local flaps. Although vascularized free flaps are an effective option in this scenario, they can add significant operative time and often yield suboptimal cosmetic results. We describe the use of the inverted gull wing titanium mesh reconstruction in the closure of 2 patients who underwent complex transzygomatic infratemporal fossa approaches for tumor with dural and sinonasal transgression. Postoperatively, there were no pseudomeningoceles, CSF leaks, or technique-related morbidities. The inverted gull wing technique represents a simple, fast, and effective closure for complex transzygomatic infratemporal fossa approaches.