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

Bozkurt, Gülpembe; Leone, Federico; Arosio, Alberto Daniele; Dehgani-Mobaraki, Puya; Elhassan, H A; Seyhun, Nurullah; Turri‐Zanoni, Mario; Castelnuovo, Paolo; Battaglia, Paolo

doi:10.1016/j.wneu.2019.04.166

Cited by 13 publications

(8 citation statements)

References 20 publications

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“…(a) For small skull base defects after resection of the tumor by endoscopic approach or transfacial approach, autologous fat packing and nasoseptal flap can be used to repair the defect. Several reports have indicated that the use of pedicled septal flap and free fat grafts is an effective and safe technique for repairing skull base defects (30)(31)(32)(33). (b) For a moderate skull base defects (generally no more than 4 cm in maximum diameter) left after transcranial approach, the dura mater can be repaired with autologous fascia and covered with adjacent pedicled myofascial flap.…”

Section: Reconstruction Of the Skull Basementioning

confidence: 99%

Clinial Features, Individualized Treatment and Long-Term Surgical Outcomes of Skull Base Meningiomas With Extracranial Extensions

Liu

Qian

et al. 2020

Front. Oncol.

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Object: Skull base meningiomas with extracranial extensions are rarely described. This study describes the clinical features, surgical management and clinical outcomes of these rare tumors and investigates risk factors associated with progression-free survival (PFS). Methods: The clinical data of 34 consecutive patients who underwent surgery for skull base meningiomas with extracranial extensions from 2007 to 2018 were retrospectively collected and analyzed. Results: The mean patient age was 47.9 ± 13.9 years; 50.0% were male. The most common symptoms on admission were ophthalmic. All patients underwent a multidisciplinary consultation before surgery, and received individualized surgical management. The gross total resection (GTR) rate was 55.9% (19/34). Twelve patients received post-operative adjuvant radiotherapy (RT). Twelve patients experienced tumor recurrence during the follow-up period. The median PFS duration was 54 months. The mean overall survival (OS) duration was 111 months. By univariate analysis, a higher histological grade (WHO grade II and III), Ki-67 LI ≥ 5 and the extent of resection (EOR) were significantly associated with tumor recurrence. Multivariate analysis revealed Ki-67 LI ≥ 5, the EOR and adjuvant RT as prognostic factor of PFS. Conclusions: These relatively rare meningiomas are difficult to resect and have a poor prognosis; they are more common in males and have a higher histological grade than intracranial meningiomas. Multidisciplinary collaboration and individualized surgical strategies are crucial for surgically managing these complex tumors. Total removal of the tumor remains challenging. Subtotal resection (STR) or partial resection (PR) followed by RT is a reasonable strategy when radical resection is infeasible. Adjuvant RT should be recommended especially for tumors with histopathological risk factors (Ki-67 LI ≥ 5 or high histological grade).

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Section: Reconstruction Of the Skull Basementioning

confidence: 99%

Clinial Features, Individualized Treatment and Long-Term Surgical Outcomes of Skull Base Meningiomas With Extracranial Extensions

Liu

Qian

et al. 2020

Front. Oncol.

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“…Grafts utilized for reconstruction consisted of autogenous fat and fascia lata, artificial dura mater, nasoseptal pedicled flap, inferior turbinate or middle turbinate mucosa flap, in consideration of tumor ranges, anatomic invaded structures and surgical process. Neither CSF rhinorrhea nor graft necrosis was found during postoperative endoscopic and radiological revision, since no bone or cartilage is used as graft material to avoid radionecrosis in the study [26] .…”

Section: Discussionmentioning

confidence: 92%

Development and validation of a postoperative nomogram for predicting overall survival after endoscopic surgical management of olfactory neuroblastoma

et al. 2020

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Background Olfactory neuroblastoma (ONB) is a rare malignancy arising in the nasal vault. Endoscopic resection has been reported to improve overall survival (OS). At present, clinicopathological predictors of the prognosis of ONB remain undefined. Methods Data including demographics, clinical characteristics and follow-up information of ONB patients treated with endoscopic surgery were collected. Risk factors on OS rates were investigated by LASSO and Cox analyses. A nomogram was developed and evaluated with internal validation. Risk groups were established according to patients’ points in the nomogram. Findings 154 ONB patients treated with surgery were included in this single center study. A nomogram based on multivariate Cox regression model including multiple tumor history, orbital invasion, carotid canal invasion, modified Kadish stage, delivery sequence of RT and surgery, sequence of chemotherapy and surgery was developed. The bias-corrected C-index (0.886 [95% CI: 0.843-0.943]) was significantly higher than of conventional staging classifications. The AUC of nomogram regarding 1-, 2- and 5-year OS probabilities reached 0.912, 0.929 and 0.957, respectively. The risk levels based on nomogram points were more discriminative than conventional classifications. Interpretation Validation analysis showed good predictive accuracy and discriminative ability of the nomogram. Therefore, the nomogram could be utilized to individually predict survival probability for ONB patients after endoscopic resection. Funding This study was funded by the Chinese Academy of Medical Sciences (No. 2019-I2M-5-003), the Shanghai Science and Technology Commission (No. 19411950600), the Shanghai Hospital Development Center (No. SHDC12018118) and the Eye, Ear, Nose and Throat Hospital of Fudan University (No. SYB202006).

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“…15 However, it may be challenging to cover the entire anterior skull base defect using this type of flap in cases where the defect is wide and anteriorly located. There has been a report in which 1 of 24 patients developed an anterior CSF leak with this method, 16 although the causal relationship was not clear. Therefore, we have devised a flap that includes the membrane of the middle turbinate, which can be used to cover the anterior area.…”

Section: Discussionmentioning

confidence: 99%

Optimal Multiple-Layered Anterior Skull Base Reconstruction Using a 360° Suturing Technique

Omura

Nomura

Mori

et al. 2021

Operative Neurosurgery

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BACKGROUND:Advances in technique and instrumentation have improved outcomes after resection of anterior skull base tumors. However, cerebrospinal fluid (CSF) leak occurs in 4%-20% of patients. To reduce the risk of CSF leak, we have developed a novel reconstruction technique that consists of a 4-layered graft with patchwork suturing and hard material.OBJECTIVE:To evaluate the effectiveness of this reconstruction technique when used for resection of anterior skull base tumors.METHODS:This case series included 59 patients with anterior skull base tumors in whom the 4-layered closure technique was used. The main outcome measures were complications, including CSF leak, meningitis, postoperative bleeding, and infection.RESULTS:There were no CSF leak cases or serious complications after closure of the anterior skull base using the 4-layered technique.CONCLUSION:Closure of the anterior skull base in 4 layers prevented CSF leak and was not associated with any serious complications. However, further studies in larger numbers of patients are needed to confirm our outcomes using this closure method.

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

Cited by 13 publications

References 20 publications

Clinial Features, Individualized Treatment and Long-Term Surgical Outcomes of Skull Base Meningiomas With Extracranial Extensions

Clinial Features, Individualized Treatment and Long-Term Surgical Outcomes of Skull Base Meningiomas With Extracranial Extensions

Development and validation of a postoperative nomogram for predicting overall survival after endoscopic surgical management of olfactory neuroblastoma

Optimal Multiple-Layered Anterior Skull Base Reconstruction Using a 360° Suturing Technique

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