Novel Surgical Treatment of Recurrent CSF Leak by Temporoparietal Temporalis Myofascial Flap: A Series of 6 Cases

Abstract

With the advent of modern endoscopes and a better anatomic understanding of the skull base, the indications of endonasal approaches are increasing. These procedures may be complicated by high rates of postoperative cerebrospinal fluid (CSF) leak, and reconstruction of the defect remains challenging. In the anterior skull base, vascularized grafts have been reported as superior in preventing CSF leakage and infection. The Hadad-Bassagasteguy flap, being a pedicled flap, is our first line flap to reconstruct the skull base. When we were not successful with this flap, we resorted to different flaps. We modified the originally described temporoparietal fascial flap by Fortes etal and applied clinically. The objective of this paper is to briefly describe the modification of the flap and to review the clinical outcome. From 2014 to 2018, in 6 cases of CSF leak with the appropriate indication, we used the temporoparietal myofascial flap repair that is a modification of the temporoparietal fascial flap by Fortes etal. We took all the 6 patients in our study and followed them up. All of the 6 repairs were successful, and no CSF leak was found just after the operation in 6- to 48-month follow-up. We recommend our modified novel temporoparietal myofascial flap as a very good option in case of failed cases of postoperative CSF leak.