Pericranial Flap‐Based Multilayer Reconstruction of Endoscopic Transcribriform Craniectomy for Sinonasal Malignancies

• Published in: The Laryngoscope 2023-11, Vol.133 (11), p.2942-2947
• Main Authors: Calvaruso, Federico, Lo Manto, Alfredo, Bisi, Nicola, Cantaffa, Carla, Basso, Margherita, Ferrulli, Giuseppe, Alicandri‐Ciufelli, Matteo, Marchioni, Daniele
• Format: Article
• Language: English
• Subjects: anterior skull base; Endoscopy; fascia lata graft; Head & neck cancer; pericranial flap; sinonasal malignancies; transcribriform approach
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.30921

Objective Diffusion of endoscopic techniques for the resection of ethmoid bone malignancies through a transcribriform approach (TA) has raised new challenges regarding reconstruction options to reduce post‐operative complications. Although there is consensus on the advantages of vascularized flaps over free grafts for large defects, no standard protocol exists on reconstruction procedures. In addition, although the pedicled nasoseptal flap has been extensively discussed, few studies have been published on extranasal pedicled flaps. The aim of this manuscript is to provide a detailed description of a reconstruction technique for large anterior skull base defects with the pericranial flap as part of a multilayered reconstruction. Moreover, patients treated with this approach were retrospectively assessed for post‐operative complications. Methods A detailed description of the reconstruction procedure as performed in our departments is provided. Pictures depicting the main surgical steps are also included. In addition, preliminary functional results from a retrospective series of patients who underwent a TA and subsequent pericranial flap‐based multilayer reconstruction for ethmoid roof malignancies between 2016 and 2022 at two institutional centers are reported. Results 16 patients were included in the study. Nine patients (56.3%) underwent adjuvant radiotherapy. Two patients had a biochemically‐confirmed postoperative CSF leak. Only one of the two patients required surgical revision. During follow‐up (mean 13 months), no other early nor delayed complications were observed. Conclusion A standardized surgical technique with pericranial flap as part of a multilayered reconstruction for large anterior skull base defects following resection of sinonasal malignancies is proposed, which appears to be a safe choice when endonasal flaps are not available. Level of Evidence Level 4 Laryngoscope, 133:2942–2947, 2023 This manuscript describes, with visual aid from intraoperative pictures, anterior skull base reconstruction with a multilayer pericranial flap‐based technique after transcribriform resection of ethmoid roof malignancies. A low post‐operative complication rate was observed in a series of 16 patients treated with this approach.