Fascia Lata: Another Workhorse for Complex Skull Base Reconstruction

Abstract

Background Multiple methods exist for skull base reconstruction of defects created by expanded endonasal approaches. While the nasoseptal flap (NSF) has been well established as the workhorse of mucosal reconstruction in complex skull base defects in multi-layered closures, a variety of options exist for the inner layer of multilayer reconstruction, including fascia lata (FL). Objective To present our experience and outcomes in utilizing FL in multiple ways to reconstruct a wide variety of complex skull base defects. Methods Retrospective review was performed from May 2017 to February 2022 to identify 50 consecutive patients who underwent endoscopic skull base reconstruction using FL. Results FL was employed for reconstruction in 50 patients included in the study: 37 undergoing primary expanded endonasal skull base surgery and 13 revision cases. A wide range of complex pathology was treated, with meningioma and craniopharyngioma being the two most common. FL was utilized as a “button” graft (34/50, 68.0%), free graft inlay/onlay (13/50, 26.0%), and as a button graft combined with onlay (3/50, 6.0%). Expanded surgery defects addressed included tuberculum sella/sphenoid planum (36/50, 72.0%), clivus (6/50, 12.0%), and cribriform/planum (8/50, 16.0%). Successful reconstruction with fascia lata was accomplished in 46/50 cases (92%), with only 4 cases (8%) requiring revision for post-op CSF leak. Donor-site complications were rare with only 1 case (2.0%) of post-op seroma. Conclusion FL, usually with NSF, offers a versatile option for the reconstruction of challenging defects with excellent outcomes and minimal morbidity. FL is emerging as a workhorse for reconstruction of the inner layer of complex skull base defects.

Skull Base Reconstruction by Subsite after Sinonasal Malignancy Resection

“…Fascia lata is a non-pedicled free graft that can be used for inlay, onlay, and button grafts for multi-layer skull base reconstruction [16]. This is often performed in conjunction with a nasoseptal flap and offers the benefit of minimal donor site morbidity.…”

“…The nasoseptal flap is a mainstay of endoscopic skull base surgery and can be used in this location, and the use of the extended NSF can help with larger defects [18]. Multi-layer reconstruction is also critical, and various techniques are utilized with collagen inlay, fascia, or alloplastic materials plus the vascularized layer [8,16,40,41]. Multiple layers in the reconstruction have been shown to be the most important variable, with the exact choice of material and inlay/onlay technique being less salient [8,41].…”

This Summer, Think Like a Vagabond

“…Wong et al 4 examine a robust collection of patients who underwent endoscopic modified medial maxillectomy and reveal that many of these patients experience an improvement in symptoms based on SNOT-22 scores, and more importantly, most of these patients did not experience further mucostasis or require revision surgery. The success and versatility of utilizing fascia lata for primary dural repair following endoscopic skull base surgery is presented by Godse et al 5 Their study demonstrates that autologous fascia lata can be used for dural reconstruction as an inlay, an onlay, or as a "button graft" in locations extending from the clivus to the cribriform. The nasoseptal flap (NSF) is the trusty workhorse for all endoscopic skull base surgeons, but the procedure is not without some risk and morbidity.…”