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Bresson D, Hudelist B, Gaudioso P, Moya-Plana A, Herman P, Idriceanu T, Nicolai P, Ferrari M. Side-door temporoparietal fascia flap: First experience with a novel technique for anterior skull base reconstruction. Head Neck 2024; 46:772-784. [PMID: 38192046 DOI: 10.1002/hed.27611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 11/16/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Modern achievements in transnasal endoscopic skull base (SB) surgery have led to complex resections that render reconstruction a challenge. Temporoparietal fascia flap (TPFF) is a suitable option for SB reconstruction. The side-door TPFF technique for anterior SB reconstruction is described here for the first time in a real-life surgical setting. METHODS Patients affected by a SB malignancy who underwent cranioendoscopic resection were included. For reconstruction, a multilayer reconstruction technique including side-door TPFF transposition was employed. RESULTS TPFF transposition was performed in five patients. The TPFF could be easily transposed via a side-door approach. It adequately covered the edges of the defect and supported optimal healing of the surgical site. During follow-up, vitality and integration of the TPFF were assessed endoscopically and radiologically. CONCLUSIONS The TPFF side-door transposition technique is a valuable option in anterior SB reconstruction that can provide fast and effective healing, especially in patients needing adjuvant radiotherapy.
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Affiliation(s)
- Damien Bresson
- Neurosurgery Department, Foch Hospital, Université Paris Saclay, Suresnes, France
| | - Benoit Hudelist
- Neurosurgery Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Piergiorgio Gaudioso
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neuroscience DNS, University of Padova, Padova, Italy
| | - Antoine Moya-Plana
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Université Paris Saclay, Villejuif, France
| | - Philippe Herman
- Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France
| | - Tania Idriceanu
- Neurosurgery Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neuroscience DNS, University of Padova, Padova, Italy
| | - Marco Ferrari
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neuroscience DNS, University of Padova, Padova, Italy
- Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, Ontario, Canada
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Xu Y, Asmaro K, Mohyeldin A, Nunez MA, Mao Y, Cohen-Gadol AA, Nayak J, Fernandez-Miranda JC. The Temporoparietal Fascia Flap Transposition Technique for Ventral Skull Base Reconstruction: Anatomic Analysis and Surgical Application. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01020. [PMID: 38189439 DOI: 10.1227/ons.0000000000001048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/26/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The temporoparietal fascia (TPF) flap is an alternative for revision endoscopic skull base reconstruction in the absence of the nasoseptal flap, and we aimed to investigate the anatomy and surgical application of TPF flap transposition in endoscopic endonasal surgery. METHODS Six lightly embalmed postmortem human heads and 30 computed tomography angiography imaging scans were used to analyze the anatomic features of the TPF flap transposition technique. Three cases selected from a 512 endoscopic endonasal cases database were presented for the clinical application of the TPF flap. RESULTS The TPF flap, composed by the deepest 3 scalp layers (galea aponeurotica, loose areolar connective tissue, and pericranium), can be harvested and then transposed through the infratemporal-maxillary-pterygoid tunnel to the ventral skull base. The superficial temporal artery as its feeding artery, gives frontal and parietal branches with similar diameter (1.5 ± 0.3 mm) at its bifurcation. The typical bifurcation was present in 50 sides (83.3%), with single (frontal) branch in 5 sides (8.3%), single (parietal) branch in 2 sides (3.3%), and multiple branches (>2) in 3 sides (5%). The transposed TPF flap was divided into 3 parts according to its anatomic location: (1) infratemporal part with an area of 19.5 ± 2.5 cm2, (2) maxillary part with an area of 23.7 ± 2.8 cm2, and (3) skull base part with an area of 44.2 ± 4 cm2. Compared with the nasoseptal flap, nasal floor flap, inferior turbinate flap, and extended septal flap, the coverage area of the skull base part of the TPF flap was significantly larger than any of them (P < .0001). CONCLUSION The TPF flap technique is an effective alternative for endoscopic endonasal skull base reconstruction. The TPF flap could successfully cover large skull base defects through the infratemporal-maxillary-pterygoid tunnel.
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Affiliation(s)
- Yuanzhi Xu
- Department of Neurosurgery, Stanford Hospital, Stanford, California, USA
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Karam Asmaro
- Department of Neurosurgery, Stanford Hospital, Stanford, California, USA
| | - Ahmed Mohyeldin
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | | | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Aaron A Cohen-Gadol
- Department of Neurological Surgery, Indiana University, Indianapolis, Indiana, USA
- The Neurosurgical Atlas, Carmel, Indiana, USA
| | - Jayakar Nayak
- Department of Neurosurgery, Stanford Hospital, Stanford, California, USA
- Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital, Stanford, California, USA
| | - Juan C Fernandez-Miranda
- Department of Neurosurgery, Stanford Hospital, Stanford, California, USA
- The Neurosurgical Atlas, Carmel, Indiana, USA
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Lin BJ, Ju DT, Hueng DY, Chen YH, Ma HI, Liu MY. Transorbital transposition of the temporoparietal fascia flap to reconstruct the skull base defects: A preclinical study with comparison to the transpterygoid transposition. Head Neck 2023; 45:2438-2448. [PMID: 37431182 DOI: 10.1002/hed.27455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Transpterygoid transposition of the temporoparietal fascia flap (TPFF) is a feasible selection for ventral skull base defect (VSBD) reconstruction, but not anterior skull base defect (ASBD) reconstruction, after expanded endoscopic endonasal approach (EEEA). The goal of this study is to introduce the transorbital transposition of the TPFF for skull base defects reconstruction after EEEA, and make quantitative comparison between the transpterygoid transposition and transorbital transposition. METHODS Cadaveric dissections were performed in five adult cadaveric heads with creating three transporting corridors bilaterally, encompassing superior transorbital corridor, inferior transorbital corridor, and transpterygoid corridor. For each transporting corridor, the minimum necessary length of the TPFF for skull base defects reconstruction was measured. RESULTS The areas of ASBD and VSBD were 1019.63 ± 176.32 mm2 and 572.99 ± 126.21 mm2 . The length of the harvested TPFF was 149.38 ± 6.21 mm. In contrast to the transpterygoid transposition with incomplete coverage, transorbital transposition of the TPFF allowed full coverage of ASBD with a minimum necessary length of 109.75 ± 8.31 mm. For VSBD reconstruction, transorbital transposition of the TPFF needs shorter minimum necessary length (123.88 ± 4.49 mm) than transpterygoid transposition (138.00 ± 6.28 mm). CONCLUSIONS Transorbital corridor is a novel pathway for transporting the TPFF into the sinonasal cavity for skull base defects reconstruction after EEEA. In comparison with transpterygoid transposition, transorbital transposition provides wider coverage of skull base defects with a fixed length of the TPFF.
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Affiliation(s)
- Bon-Jour Lin
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Da-Tong Ju
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Dueng-Yuan Hueng
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yuan-Hao Chen
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-I Ma
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ming-Ying Liu
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Idriceanu T, Hudelist B, Moya-Plana A, Bresson D. How I do it: epidural transposition of the temporoparietal fascia flap for anterior skull base reconstruction. Acta Neurochir (Wien) 2023; 165:2327-2331. [PMID: 37103586 DOI: 10.1007/s00701-023-05602-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/16/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Multilayer closures and the use of vascularized flaps have been showed to be very effective in the reconstruction of the anterior skull base (ASB) after extended endonasal approaches resulting in large bone and dural defects. In the case of unavailability of a local flap, regional ones like the temporoparietal fascia flap (TPFF), used until now via a transpterygoïd route (Bolzoni Villaret et al. in Eur Arch Otorhinolaryngol 270(4):1473-1479, 2023; Fortes et al. in Laryngoscope 117(6):970-976, 2017; Veyrat et al. in Acta Neurochir (Wien) 158(12):2291-2294, 2016), can be an effective alternative. METHOD We describe a step-by-step technique of TPFF transposition via an epidural supraorbital corridor for the reconstruction of a large midline ASB defect. CONCLUSION TPFF is a promising alternative for the reconstruction of the ASB defects.
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Affiliation(s)
- Tania Idriceanu
- Neurosurgery Department, AP-HP, Henri Mondor University Hospital, 51 avenue du Marechal de Lattre de Tassigny, 94000, Créteil, France.
| | - Benoit Hudelist
- Neurosurgery Department, AP-HP, Henri Mondor University Hospital, 51 avenue du Marechal de Lattre de Tassigny, 94000, Créteil, France
| | | | - Damien Bresson
- Neurosurgery Department, Foch University Hospital, 92150, Suresnes, France
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Arosio AD, Coden E, Karligkiotis A, Volpi L, Petruzzi G, Pellini R, Battaglia P, Castelnuovo P, Bignami M. Temporoparietal Fascia Flap Endonasal Transposition in Skull Base Reconstruction: Surgical Technique. World Neurosurg 2020; 146:118. [PMID: 33166688 DOI: 10.1016/j.wneu.2020.10.169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 11/17/2022]
Abstract
Reconstruction of wide skull base defects resulting from multimodal treatment of cranial base malignancies are challenging.1 Endonasal pedicled flaps (e.g., Hadad-Bassagusteguy flap)1,2 are generally the first choice; however, inadequacy for the size and location of the defect or their unavailability are common occurrences in salvage reconstructions, and prior irradiation is an additional unfavorable condition for local flap viability. The temporoparietal fascia flap (TPFF)3 is a regional flap vascularized by the superficial temporal artery, which is able to survive and integrate even in postirradiated areas. Its properties, such as thinness, pliability, foldability, and the long pedicle, make it a versatile flap for reconstruction of various defects of the skull base, both in adults3-7 and children.8 In lateral skull surgery, TPFF proved to be effective in patients at higher risk of cerebrospinal fluid leak,7 whereas its transposition into the nasal cavity through a temporal-infratemporal tunnel has been widely reported to repair defects of the ventral skull base.3-6 It represents a safe and effective technique with minimal additional morbidity (potential alopecia or scalp necrosis).4,5 A recently described modification of this technique supports TPFF transposition via a supraorbital epidural corridor to reach the anterior skull base, especially for large defects with supraorbital extension.6 The present video (Video 1) shows the step-by-step TPFF harvesting and endonasal transposition via a temporal-infratemporal tunnel to repair a wide middle cranial fossa defect resulting from osteoradionecrosis after endoscopic resection and heavy-particle radiation therapy for sinonasal adenoid-cystic carcinoma. At 6-months follow-up, optimal healing without complications was observed.
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Affiliation(s)
- Alberto Daniele Arosio
- Department of Otorhinolaryngology-Head and Neck Surgery, ASST Sette Laghi, Ospedale di Circolo, University of Insubria, Varese, Italy
| | - Elisa Coden
- Department of Otorhinolaryngology-Head and Neck Surgery, ASST Sette Laghi, Ospedale di Circolo, University of Insubria, Varese, Italy.
| | - Apostolos Karligkiotis
- Department of Otorhinolaryngology-Head and Neck Surgery, ASST Sette Laghi, Ospedale di Circolo, University of Insubria, Varese, Italy
| | - Luca Volpi
- Department of Otorhinolaryngology-Head and Neck Surgery, ASST Sette Laghi, Ospedale di Circolo, University of Insubria, Varese, Italy
| | - Gerardo Petruzzi
- Department of Otorhinolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Raul Pellini
- Department of Otorhinolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Battaglia
- Department of Otorhinolaryngology-Head and Neck Surgery, ASST Sette Laghi, Ospedale di Circolo, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology-Head and Neck Surgery, ASST Sette Laghi, Ospedale di Circolo, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Maurizio Bignami
- Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Department of Otorhinolaryngology-Head and Neck Surgery, ASST Lariana, Sant'Anna Hospital, University of Insubria, San Fermo della Battaglia, Como, Italy
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