Background: Endoscopic endonasal anterior skull base malignant sinonasal tumor resection and reconstruction remains a challenge. We describe our septal flip flap (SFF) reconstruction, a new surgical technique for repairing anterior skull base defects and report our outcomes. Methods: We retrospectively reviewed the clinical data of 24 patients who underwent skull base reconstruction using a SFF following endoscopic resection with transnasal craniectomy. We raise the SFF from the contralateral nasal septum based on the septal branches of the anterior and posterior ethmoidal arteries; the SFF is then rotated laterally for anterior skull base reconstruction after transnasal resection with craniectomy. Results: The SFF was used for multiple tumor types including, most commonly, intestinal-type adenocarcinoma, followed by olfactory neuroblastoma, squamous cell carcinoma, sinonasal undifferentiated carcinoma, and other types. All of the cases had either preoperative or postoperative radiation therapy. All flaps remained viable postoperatively. Postoperatively, nasal crusting was significantly reduced with faster healing of the surgical cavity. Conclusions: The SFF adds to the clinical armamentarium the opportunity to provide vascularized mucosal coverage extending from the frontal recess back to the planum sphenoidalis. The use of SFF requires careful consideration when dealing with paranasal sinus cancers so as not to infringe oncologic principles.

Septal Flip Flap for Anterior Skull Base Reconstruction After Endoscopic Transnasal Craniectomy: Long-Term Outcomes

Castelnuovo P.;Battaglia P.;TURRI ZANONI, MARIO
2019-01-01

Abstract

Background: Endoscopic endonasal anterior skull base malignant sinonasal tumor resection and reconstruction remains a challenge. We describe our septal flip flap (SFF) reconstruction, a new surgical technique for repairing anterior skull base defects and report our outcomes. Methods: We retrospectively reviewed the clinical data of 24 patients who underwent skull base reconstruction using a SFF following endoscopic resection with transnasal craniectomy. We raise the SFF from the contralateral nasal septum based on the septal branches of the anterior and posterior ethmoidal arteries; the SFF is then rotated laterally for anterior skull base reconstruction after transnasal resection with craniectomy. Results: The SFF was used for multiple tumor types including, most commonly, intestinal-type adenocarcinoma, followed by olfactory neuroblastoma, squamous cell carcinoma, sinonasal undifferentiated carcinoma, and other types. All of the cases had either preoperative or postoperative radiation therapy. All flaps remained viable postoperatively. Postoperatively, nasal crusting was significantly reduced with faster healing of the surgical cavity. Conclusions: The SFF adds to the clinical armamentarium the opportunity to provide vascularized mucosal coverage extending from the frontal recess back to the planum sphenoidalis. The use of SFF requires careful consideration when dealing with paranasal sinus cancers so as not to infringe oncologic principles.
2019
Cerebrospinal fluid leak; Craniectomy; Septal flip flap; Skull base reconstruction; Vascularized mucosal flap; Adenocarcinoma; Adolescent; Adult; Aged; Carcinoma; Craniotomy; Esthesioneuroblastoma, Olfactory; Female; Humans; Male; Maxillary Sinus Neoplasms; Middle Aged; Nasal Cavity; Nasal Septum; Natural Orifice Endoscopic Surgery; Neuroendoscopy; Nose Neoplasms; Paranasal Sinus Neoplasms; Reconstructive Surgical Procedures; Retrospective Studies; Skull Base; Squamous Cell Carcinoma of Head and Neck; Young Adult; Surgical Flaps
Bozkurt, G.; Leone, F.; Arosio, A. D.; Dehgani Mobaraki, P.; Elhassan, H. A.; Seyhun, N.; Turri-Zanoni, M.; Castelnuovo, P.; Battaglia, P.; TURRI ZANONI, Mario
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11383/2094131
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