Abstract
Background
Multilayer closures and the use of vascularized flaps have been showed to be very effective in the reconstruction of the anterior skull base (ASB) after extended endonasal approaches resulting in large bone and dural defects. In the case of unavailability of a local flap, regional ones like the temporoparietal fascia flap (TPFF), used until now via a transpterygoïd route (Bolzoni Villaret et al. in Eur Arch Otorhinolaryngol 270(4):1473–1479, 2023; Fortes et al. in Laryngoscope 117(6):970–976, 2017; Veyrat et al. in Acta Neurochir (Wien) 158(12):2291–2294, 2016), can be an effective alternative.
Method
We describe a step-by-step technique of TPFF transposition via an epidural supraorbital corridor for the reconstruction of a large midline ASB defect.
Conclusion
TPFF is a promising alternative for the reconstruction of the ASB defects.
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Abbreviations
- TPFF:
-
Temporoparietal fascia flap
- STA:
-
Superficial temporal artery
- EEA:
-
Endoscopic endonasal approach
- ASB:
-
Anterior skull base
- CSF:
-
Cerebrospinal fluid
- CTA:
-
Computed tomography angiography
References
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Ferrari M, Vural A, Schreiber A et al (2019) Side-door temporoparietal fascia flap: a novel strategy for anterior skull base reconstruction. World Neurosurg 126:e360–e370
Fortes FSG, Carrau RL, Snyderman CH, Kassam A, Prevedello D, Vescan A, Mintz A, Gardner P (2007) Transpterygoid transposition of a temporoparietal fascia flap: a new method for skull base reconstruction after endoscopic expanded endonasal approaches. Laryngoscope 117(6):970–976
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Veyrat M, Verillaud B, Herman P, Bresson D (2016) How I do it. The pedicled temporoparietal fascia flap for skull base reconstruction after endonasal endoscopic approaches. Acta Neurochir (Wien) 158(12):2291–2294
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Key points
1. Selected indications only for the use of the TPPF in the reconstruction of the ASB due to the fact that this procedure adds extra morbidity by requiring a large skin incision and a bone flap.
2. Computer tomography angiography is mandatory to assess the anatomy of the STA.
3. STA anatomy dictates the donor side.
4. A flap with a length of 17 cm is sufficient to achieve most reconstructions.
5. The flap should be wider at the distal end to surpass the area of the bone defect.
6. Avoid excessive tension of the pedicle when pulling the flap from the nose during reconstruction.
7. Flap viability check with Doppler at the end of surgery.
8. Special consideration when transposing the flap to avoid the twist of the pedicle.
9. Nasal wash with a saline solution is advisable for at least 4 to 6 weeks.
10. Regular endoscopic look to assess the healing process.
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Idriceanu, T., Hudelist, B., Moya-Plana, A. et al. How I do it: epidural transposition of the temporoparietal fascia flap for anterior skull base reconstruction. Acta Neurochir 165, 2327–2331 (2023). https://doi.org/10.1007/s00701-023-05602-w
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DOI: https://doi.org/10.1007/s00701-023-05602-w