The Temporoparietal Fascial Flap for Endoscopic Cranial Base Reconstruction: Technique, Indications, and Case Series

Abstract

Objective: To describe our indications for the temporoparietal fascia flap (TPFF) in endoscopic cranial base reconstruction, our evolution in technique, and our case series. Methods: Retrospective chart review at a tertiary care center. Results: The two patients in our series had malignant neoplasms of the skull base that received preoperative radiation. The intranasal vascularized options for cerebrospinal fluid (CSF) leak repair were therefore unavailable. One patient was treated for osteoradionecrosis of the central cranial base, and the other patient received a TPFF for reconstruction after primary resection. The TPFF flap was harvested in the standard open fashion based on the superficial temporal vessels. It was then passed through the infratemporal fossa into the defect of the skull base and nasopharynx, without the need for osteotomies, and secured into place. Median follow-up of 14 months demonstrated no CSF leak. One patient developed severe epistaxis related to the resection requiring embolization. There was no donor site morbidity. Currently, both patients have fully healed. Conclusion: The TPFF is an effective means of endoscopic cranial base reconstruction with minimal complications. It serves as a reliable vascularized method of reconstruction when other intranasal vascularized flaps are unavailable.