Journal of Neurosurgical Sciences 2021 Jan 22

DOI: 10.23736/S0390-5616.20.05087-0

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Reconstruction after extended endonasal approaches to the anterior cranial base - surgical techniques and current results

Erion J. de ANDRADE ^{1, 2}, João Paulo ALMEIDA ^{1, 2}, Hamid BORGHEI-RAZAVI ³, Zachary J. CAPELLO ³, Dennis TANG ⁴ , Troy D. WOODWARD ⁴, Raj SANDWANI ⁴, Varun R. KSHETTRY ^{1, 2} , Pablo F. RECINOS ^{1, 2, 4} ✉

¹ Section of Skull Base Surgery, Department of Neurological Surgery, Neurological Institute Cleveland Clinic, Cleveland, OH, USA; ² Minimally Invasive Cranial Base and Pituitary Surgery Program, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; ³ Department of Neurosurgery Neurological Institute Cleveland Clinic, Weston, FL, USA; ⁴ Department of Otolaryngology and Head and Neck Surgery, Cleveland Clinic, Cleveland, OH, USA

The development of extended endoscopic endonasal approaches (EEA) to the anterior skull base has allowed successful resection of selected extradural and intradural skull base tumors through an endonasal corridor, minimizing brain and cranial nerve manipulation. However, as the complexity of the approaches has increased so has the need for more robust and reliable reconstructive options to minimize morbidity. Reconstructive decision-making after extended EEA for anterior skull base tumors must take into consideration multiple factors including patient characteristics (body-mass index, previous surgeries, and radiation), location, and size of the skull base defect. A multilayered reconstruction which includes a combination of free grafts and a vascularized flap is the standard approach to anterior skull base defects after EEA and should be applied in a stepwise manner tailored to each patient. The techniques and materials used to accomplish skull base repair are discussed, the outcomes in the literature are reviewed, and our reconstructive paradigm presented.

KEY WORDS: Skull base; Cerebrospinal fluid leak; Reconstruction; Endoscopic; Pedicled flaps, anterior skull base