Complex Skull Research Articles

A Concept of "Boundary Determination" by the Combination of a Local Flap and Free Tissue Transfer Useful for the Prevention of Postoperative Complications After Complex and Widespread Skull Base Reconstruction.

The transplanted tissue is sutured to the stumps of the bones in skull base reconstruction. Concerning reconstruction by free tissue transfer, it is difficult that the tissue is accurately sutured/fixed to a complex three-dimensional structure. The authors devised a technique in which free tissue transfer is combined with a local flap. A pericranial flap is sutured/fixed onto the irregular border between the cranial and nasal cavities. A free tissue graft is transplanted cranial or caudal to the determined border. Clinical presentation 1 is a patient with carcinoma of the frontal sinus (T4bN0M0). Resection of the frontal bone/nasal bone/medial and superior walls of the orbit, frontal lobectomy was performed. Clinical presentation 2 is a patient with carcinoma of the maxillary sinus (T4aN0M0). Extended total maxillectomy, simultaneous resection of the facial skin/temporal muscle were performed. There were no serious postoperative complications related to compression or occlusion of the cerebral parenchyma or paranasal sinus.

How I do it: superficial temporal artery-middle cerebral artery bypass for flow augmentation and replacement.

The superficial temporal artery-middle cerebral artery (STA-MCA) bypass augments blood flow in patients with cerebral ischemia or replaces flow in patients with complex aneurysms or skull base tumors requiring vessel sacrifice. We provide a description of the STA-MCA bypass with figures and video to illustrate the procedure. The STA-MCA end-to-side anastomosis is a foundational skill for the cerebrovascular surgeon and a building block for more complex bypasses.

Non-invasive prediction of intracranial hypertension in patients with craniosynostosis using computed tomography

ObjectiveThis study aimed to verify that children with craniosynostosis could be diagnosed with intracranial hypertension prior to surgery. We planned to use a computed tomography (CT)-based technique that can predict preoperatively the presence of intracranial hypertension. MethodsThe study group included consecutive children with craniosynostosis, with 27 patients who were to undergo surgery between 2008 and 2018. The control group included 90 children who underwent CT for a minor reason. The craniosynostosis children underwent CT prior to surgery. The inner and outer cranial circumferences and area were automatically measured from scan data. The circularity (which determines skull inner shape and area) and the C-ratio (the ratio of the inner/outer circumferences) were calculated. ResultsBoth the circularity and the C-ratio in the craniosynostosis group were low significantly, indicating more complex skull inner surface than the controls and thus more severe digital impression. When analyzed for age group, the both values were significantly lower in the <3 group than in the controls. The circularity and C-ratio indicated more severe digital impression and thus possible intracranial hypertension. ConclusionOur novel evaluation for intracranial hypertension in craniosynostosis is less invasive procedure than conventional method and useful for screening or regular follow-up.

The pedicled temporoparietal fascial flap

The pedicled temporoparietal fascial flap has played a role in reconstructive strategies for defects of the head and neck for well over a century. Although partially succeeded by more recent microvascular free tissue transfer techniques, this well-vascularized and pliable flap has remained an important tool in the reconstruction of locoregional defects of the temporal bone, orbitomaxillary complex, and anterior skull base. Furthermore, with little donor site morbidity and relative ease of harvest this flap is likely to remain a key tool in the reconstructive armamentarium of head and neck and skull base surgeons. In this article we review the anatomy, operative technique, potential complications, and applications of the pedicled temporoparietal fascial flap.

The modified technique for a complex scalp and skull reconstruction due to the extreme electrical burn: a case report with review of literature

The modified technique for a complex scalp and skull reconstruction due to the extreme electrical burn: a case report with review of literature

The quiet revolution: retractorless surgery for complex vascular and skull base lesions

The quiet revolution: retractorless surgery for complex vascular and skull base lesions

Three dimensional methylacrylate and wax skull modeling preparing cranioplasty in the treatment of complex craniosynostosis and skull malformation

Three dimensional methylacrylate and wax skull modeling preparing cranioplasty in the treatment of complex craniosynostosis and skull malformation

Real-time computed tomography image update for endoscopic skull base surgery

The development of computer-aided systems for endoscopic sinus surgery has enabled surgical navigation through diseased or surgically altered sinus anatomy with increased confidence. However, conventional computer-aided systems do not provide intra-operative updated computed tomography imaging. We describe the technical aspects of the xCAT, a new intra-operative mobile volume computed tomography scanner. A patient with a malignant melanoma unwittingly removed at another hospital underwent surgery for removal of the lateral nasal wall and directed biopsies, in an attempt to identify the site of tumour origin. The procedure was performed with the GE InstaTrak 3500 Plus computer-aided system, updated with intra-operative computed tomography images. Intra-operative, updated images were integrated successfully into the InstaTrak system, and these images were consistent with the observed endoscopic anatomy. The xCAT intra-operative mobile volume computed tomography scanner is a technological advancement that can assist the endoscopic sinus surgeon when performing complex rhinological and skull base procedures.

Surgical Outcomes of Drill-Out Procedures for Management of Complex Frontal and Skull Base Pathology

Surgical Outcomes of Drill-Out Procedures for Management of Complex Frontal and Skull Base Pathology

The surgical one-stage management of frontobasal fractures

The surgical approaches that are presently used for the treatment of traumatic injuries of the anterior skull base have evolved over the past 30 years. We present a retrospective review of 34 trauma cases involving patients who underwent the extended, subcranial approach to the anterior skull base and the facial skeleton during a period of 5 years. Patient records were retrospectively reviewed and tabulated for age, sex, and indications for procedure. Special emphasis was placed on early outcome and complications. Preoperative patient evaluation and the surgical technique are also reviewed. Based on our review, we believe that the extended subcranial approach to the anterior skull base is a safe, versatile, and effective procedure for the definitive surgical treatment of complex craniofacial and skull base fracture.

Intracranial Placement of a Nasogastric Tube after Complex Craniofacial Trauma

The complication of intracranial placement of a nasogastric tube in patients with complex facial and skull base fractures is rarely seen. A case report of a patient with complex craniofacial injury after trauma in whom a computerized tomogram scan showed passage of a nasogastric tube via a fracture of the anterior cranial fossa floor into the skull vault is presented. This case stresses the caution to be exercised in the emergency room resusitation of patients with craniofacial injury requiring nasogastric tube placement.