• World Neurosurg · Jun 2019

    "Side door"-temporoparietal fascia flap: a novel strategy for anterior skull base reconstruction.

    • Marco Ferrari, Alperen Vural, Alberto Schreiber, Davide Mattavelli, Tommaso Gualtieri, Stefano Taboni, Giacomo Bertazzoni, Vittorio Rampinelli, Michele Tomasoni, Barbara Buffoli, Francesco Doglietto, Luigi Fabrizio Rodella, Alberto Deganello, and Piero Nicolai.
    • Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy. Electronic address: 1990marcoferrari@gmail.com.
    • World Neurosurg. 2019 Jun 1; 126: e360-e370.

    BackgroundThe armamentarium for anterior skull base (ASB) reconstruction includes a variegate spectrum of grafts, endonasal pedicled flaps, regional pedicled flaps, and free flaps, which are selected to face specific scenarios. The use of a vascularized flap in case of large ABS defects ensures an adequate blood supply. The aim of this study was to evaluate the possible role of temporoparietal fascia flap (TPFF) in ASB reconstruction.MethodsEight fresh-frozen head specimens were dissected to evaluate the adequacy of TPFF and pericranial flap (PF) for the reconstruction of ASB defects. The percentage of coverage of the ASB was calculated for TPFF and PF. An anatomic-radiologic analysis was performed to provide useful practical information for flap harvesting and positioning.ResultsThe TPFF was easily transposed to the ABS defect through an epidural corridor; the edges of the TPFF were successfully placed in the intradural space, in the epidural space, or on the extracranial surface of the ABS defect. The PF was particularly adequate for median defects, and the TPFF was shown to be useful also in cases with paramedian-supraorbital extension. The median percentage of coverage of the ASB was significantly higher for TPFF (85.1%) than PF (65.7%) (P = 0.018).ConclusionsThe supraorbital epidural corridor is a possible novel pathway for transposition of the TPFF for ASB reconstruction. Side-door TPFF was shown to be an ideal choice for large ASB defect with lateral supraorbital extension and could be useful in the scenario of salvage reconstruction for recurrent ABS cerebrospinal fluid leak.Copyright © 2019 Elsevier Inc. All rights reserved.

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