• Edoardo Porto, Jackson Vuncannon, J Manuel Revuelta-Barbero, Alejandra Rodas, Justin Maldonado, Tomas Garzon-Muvdi, Emily Barrow, Gustavo Pradilla, and C Arturo Solares.
• Department of Neurosurgery, Emory University, Atlanta, Georgia USA.
• World Neurosurg. 2023 May 1; 173: 108113108-113.

BackgroundThe radial forearm free flap (RFFF) is an indispensable tool for the reconstruction of a range of defects, including those of the skull base. Several options for routing of the RFFF pedicle have been described, and the parapharyngeal corridor (PC) has been proposed as an option and employed for a nasopharyngeal defect. However, there are no reports of its use for the reconstruction of anterior skull base defects. The objective of this study is to describe the technique for free tissue reconstruction of anterior skull base defects using the RFFF and routing of the pedicle via the PC.MethodsRelevant neurovascular landmarks and critical surgical steps for reconstruction of anterior skull base defects with an RFFF and routing of the pedicle via the PC are reported using an illustrative clinical case and cadaveric dissections.ResultsWe present a case of a 70-year-old man who underwent endoscopic transcribriform resection of cT4N0 sinonasal squamous cell carcinoma and was left with a large anterior skull base defect that persisted despite several repair attempts. An RFFF was utilized to repair the defect. This report is the first description of the clinical use of the PC for free tissue repair of an anterior skull base defect.ConclusionsThe PC is an option for routing the pedicle during the reconstruction of anterior skull base defects. When the corridor is prepared as described in this case, a direct route exists from the anterior skull base to cervical vessels, simultaneously maximizing the reach of the pedicle and minimizing the risk of kinking.Copyright © 2023 Elsevier Inc. All rights reserved.

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