The temporo-parietal fascial flap in extended transnasal endoscopic procedures: cadaver dissection and personal clinical
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The temporo-parietal fascial flap in extended transnasal endoscopic procedures: cadaver dissection and personal clinical experience Andrea Bolzoni Villaret • Piero Nicolai • Alberto Schreiber • Andrea Bizzoni • Davide Farina • Manfred Tschabitscher
Received: 8 July 2012 / Accepted: 7 September 2012 / Published online: 21 September 2012 Ó Springer-Verlag 2012
Abstract Due to progressively expanded indications of endoscopic transnasal surgery, having different reconstructive options in the armamentarium becomes of paramount importance. We herein report our experience with the use of the temporo-parietal fascial flap after extended endoscopic procedures for malignancies of the clival and nasopharyngeal regions. We focus our report on the surgical anatomy of this flap and the technique for its intranasal transposition through an infratemporal corridor. The main steps of the procedure and anatomic landmarks were highlighted, thanks to previous cadaver dissection. Five patients underwent an extended endoscopic resection for malignant tumors: one with persistent clival chordoma, three with recurrent nasopharyngeal carcinomas, and 1 recurrent nasopharyngeal adenoid cystic carcinoma. In all patients a temporo-parietal fascial flap was harvested to protect critical structures or irradiated denuded bone. The Mean harvesting and hospitalization time were 120 min and 5 days, respectively. No major or minor complications were observed. Whenever local flaps are not available for oncologic reasons or previous surgery, the temporo-parietal fascial flap is a safe and relatively easy option to protect the residual skull base and critical structures such as the
A. Bolzoni Villaret P. Nicolai A. Schreiber (&) A. Bizzoni Department of Otorhinolaryngology, University of Brescia, Piazza, Spedali Civili 1, 25100 Brescia, Italy e-mail: [email protected] D. Farina Department of Radiology, University of Brescia, Piazza, Spedali Civili 1, 25100 Brescia, Italy M. Tschabitscher Department of Systematic Anatomy, Medical University of Wien, Vienna, Austria
internal carotid artery and dura of the posterior cranial fossa, after extended endoscopic resections. Keywords Skull base Endoscopic surgery Flap Nasopharyngectomy
Introduction During the last 10 years, indications for endonasal approaches have expanded as a result of a better understanding of the anatomy from an endoscopic perspective, increasing surgical expertise, and concomitant technological advances in instrumentation and image-guided navigation systems. The possibility to perform an endoscopic resection of the anterior skull base and overlying dura with subsequent repair of the defect as described by Kassam et al. [1] has opened new possibilities in the management of sinonasal and skull base malignancies. As previously reported by our group, the use of autologous materials such as the iliotibial tract and fat tissue together with the standardized three-layer reconstruction in the repair of large anterior skull base defects has led to a decrease in t
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