Palatal Flap Modifications Allow Pedicled Reconstruction of the Skull Base

Oliver, Christopher; Hackman, Trevor; Carrau, Ricardo L.; Snyderman, Carl H.; Kassam, Amin; Prevedello, Daniel M.; Gardner, Paul A.

doi:10.1097/mlg.0b013e318184e719

Cited by 104 publications

(55 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These data confirm the pertinent literature that shows a postoperative CSF leakage rate of 18.4% (range 3.8%-69%) 7,20,32,44,70 and, once again, sheds light on one of the main issues of this kind of surgery. 11,13,26,58,69,95 Recently, several reconstruction techniques have been defined and popularized; such new strategies, combined with the use of new materials including vascularized flaps, 31,36,58,79,101 significantly reduce such risks. Indeed, in our series the postoperative CSF leak rate fell to 4% in the last 25 procedures.…”

Section: Postoperative Complicationsmentioning

confidence: 99%

The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients

Cavallo

Günther

Cappabianca

et al. 2014

JNS

202

198

View full text Add to dashboard Cite

Object Despite their benign histological appearance, craniopharyngiomas can be considered a challenge for the neurosurgeon and a possible source of poor prognosis for the patient. With the widespread use of the endoscope in endonasal surgery, this route has been proposed over the past decade as an alternative technique for the removal of craniopharyngiomas. Methods The authors retrospectively analyzed data from a series of 103 patients who underwent the endoscopic endonasal approach at two institutions (Division of Neurosurgery of the Università degli Studi di Napoli Federico II, Naples, Italy, and Division of Neurosurgery of the Bellaria Hospital, Bologna, Italy), between January 1997 and December 2012, for the removal of infra- and/or supradiaphragmatic craniopharyngiomas. Twenty-nine patients (28.2%) had previously been surgically treated. Results The authors achieved overall gross-total removal in 68.9% of the cases: 78.9% in purely infradiaphragmatic lesions and 66.3% in lesions involving the supradiaphragmatic space. Among lesions previously treated surgically, the gross-total removal rate was 62.1%. The overall improvement rate in visual disturbances was 74.7%, whereas worsening occurred in 2.5%. No new postoperative defect was noted. Worsening of the anterior pituitary function was reported in 46.2% of patients overall, and there were 38 new cases (48.1% of 79) of postoperative diabetes insipidus. The most common complication was postoperative CSF leakage; the overall rate was 14.6%, and it diminished to 4% in the last 25 procedures, thanks to improvement in reconstruction techniques. The mortality rate was 1.9%, with a mean follow-up duration of 48 months (range 3–246 months). Conclusions The endoscopic endonasal approach has become a valid surgical technique for the management of craniopharyngiomas. It provides an excellent corridor to infra- and supradiaphragmatic midline craniopharyngiomas, including the management of lesions extending into the third ventricle chamber. Even though indications for this approach are rigorously lesion based, the data in this study confirm its effectiveness in a large patient series.

show abstract

Section: Postoperative Complicationsmentioning

confidence: 99%

The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients

Cavallo

Günther

Cappabianca

et al. 2014

JNS

202

198

View full text Add to dashboard Cite

show abstract

“…This has been solved with a combination of techniques including inlay and onlay fascial grafts, direct suturing of dural grafts, fat grafts, the introduction of vascularized pedicled flaps, and intranasal support with a balloon catheter. 15,[16][17][18][19][20] Our preferred technique is a septal mucosal flap pedicled on the posterior septal artery from the sphenopalatine foramen. This provides complete coverage of a craniofacial defect from the frontal sinuses to the planum sphenoidale and from orbit to orbit (Fig.…”

Section: Prevention Of Complicationsmentioning

confidence: 99%

What Are the Limits of Endoscopic Sinus Surgery?: The Expanded Endonasal Approach to the Skull Base

Snyderman¹,

Pant²,

Carrau³

et al. 2009

Keio J. Med.

Self Cite

207

171

View full text Add to dashboard Cite

“…As mentioned above, this fl ap is useful for repairing a cleft palate [ 86 ] and, less commonly, it can be used to resolve defects of the base of the skull [ 87 ]. Lee proposed a technique for reconstructing oroantral communication defect and using a delayed autologous bone graft for subsequent placement of implants [ 88 ] (Figs.…”

Section: Indicationsmentioning

confidence: 97%

Reconstruction of Soft Tissue Defects with Regional Flaps

Escobar

Cruz

López

et al. 2015

Reconstructive Oral and Maxillofacial Surgery

View full text Add to dashboard Cite

Regional fl aps are pedicle fl aps obtained from anatomical regions close to the defect to be constructed. Their advantages over pedicle fl aps are similarity with the skin adjacent to the defect (color, texture, and hair), the speed with which they can be harvested, and the lower cost, lower comorbidity, and lower personnel and infrastructure requirements. Their disadvantages are their limited size, limited distance between the donor site and the receptor site, and lower predictability when preparing compound fl aps with bone. Regional fl aps can sometimes be combined with microvascular free fl aps for the reconstruction of complex defects.

show abstract

Palatal Flap Modifications Allow Pedicled Reconstruction of the Skull Base

Abstract: Our novel modifications to the island palatal flap yield a large (12-18 cm(2)) mucoperiosteal flap based on a approximately 3 cm pedicle. The Oliver pedicled palatal flap shows potential for nasal cavity and skull base reconstruction (see video, available online only).

Cited by 104 publications

References 12 publications

The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients

The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients

What Are the Limits of Endoscopic Sinus Surgery?: The Expanded Endonasal Approach to the Skull Base

Reconstruction of Soft Tissue Defects with Regional Flaps

Contact Info

Product

Resources

About