Microsurgical Anatomy of Temporoparietal Fascia Flap Transposition Technique: Implications in Ventral Skull Base Reconstruction

Abstract

Objective: Revision endoscopic endonasal skull base surgery for failure of skull base reconstruction is most often successful using a variety of surgical techniques, from the simplest flap repositioning, grafting reinforcement and lumbar drain placement to the more advanced application of alternative vascularized flaps, such as the nasal floor flap, inferior turbinate flap, or contralateral nasoseptal flap. Although uncommon, failure of the skull base reconstruction in spite of all previous measures may result in an extreme situation with potentially devastating outcome. At this point, the temporoparietal fascia (TPF) flap is an alternative in the absence of the nasoseptal flap, but its detailed anatomic analysis and technical nuances remain rarely reported. We aimed to investigate the anatomy and surgical application of TPF flap transposition in endoscopic endonasal surgery.