• Braz J Otorhinolaryngol · Jul 2019

    Case Reports

    Endoscopic endonasal double flap technique for reconstruction of large anterior skull base defects: technical note.

    • Dolci Ricardo Landini Lutaif RLL Santa Casa de Misericórdia de São Paulo, Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil. Elec, Alexandre Bossi Todeschini, Santos Américo Rubens Leite Dos ARLD Santa Casa de Misericórdia de São Paulo, Faculdade de Ciências Médicas, Departamento de Cirurgia, Disciplina de Neurocirurgia, São Pa, and Paulo Roberto Lazarini.
    • Santa Casa de Misericórdia de São Paulo, Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil. Electronic address: landini37@hotmail.com.
    • Braz J Otorhinolaryngol. 2019 Jul 1; 85 (4): 427-434.

    IntroductionOne of the main concerns in endoscopic endonasal approaches to the skull base has been the high incidence and morbidity associated with cerebrospinal fluid leaks. The introduction and routine use of vascularized flaps allowed a marked decrease in this complication followed by a great expansion in the indications and techniques used in endoscopic endonasal approaches, extending to defects from huge tumours and previously inaccessible areas of the skull base.ObjectiveDescribe the technique of performing endoscopic double flap multi-layered reconstruction of the anterior skull base without craniotomy.MethodsStep by step description of the endoscopic double flap technique (nasoseptal and pericranial vascularized flaps and fascia lata free graft) as used and illustrated in two patients with an olfactory groove meningioma who underwent an endoscopic approach.ResultsBoth patients achieved a gross total resection: subsequent reconstruction of the anterior skull base was performed with the nasoseptal and pericranial flaps onlay and a fascia lata free graft inlay. Both patients showed an excellent recovery, no signs of cerebrospinal fluid leak, meningitis, flap necrosis, chronic meningeal or sinonasal inflammation or cerebral herniation having developed.ConclusionThis endoscopic double flap technique we have described is a viable, versatile and safe option for anterior skull base reconstructions, decreasing the incidence of complications in endoscopic endonasal approaches.Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

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