How to choose? Endoscopic skull base reconstructive options and limitations.

Journal Article (Journal Article)

As endoscopic skull base resections have advanced, appropriate reconstruction has become paramount. The reconstructive options for the skull base include both avascular and vascular grafts. We review these and provide an algorithm for endoscopic skull base reconstruction. One hundred and sixty-six skull base dural defects, reconstructed with an endonasal vascular flap, were examined. As an adjunct, avascular reconstruction techniques are discussed to illustrate all options for endonasal skull base reconstruction. Cerebrospinal fluid (CSF) leak rates are also discussed. Small CSF leaks may be successfully repaired with various avascular grafting techniques. Endoscopic endonasal approaches (EEAs) to the skull base often have larger dural defects with high-flow CSF leaks. Success rates for some EEA procedures utilizing avascular grafts approach 90%, yet in high-flow leak situations, success rates are much lower (50 to 70%). Defect location and complexity guides vascularized flap choice. When nasoseptal flaps are unavailable, anterior/sellar defects are best managed with an endoscopically harvested pericranial flap, whereas clival/posterior defects may be reconstructed with an inferior turbinate or temporoparietal flap. An endonasal skull base reconstruction algorithm was constructed and points to increased use of various vascularized reconstructions for more complex skull base defects.

Full Text

Duke Authors

Cited Authors

  • Patel, MR; Stadler, ME; Snyderman, CH; Carrau, RL; Kassam, AB; Germanwala, AV; Gardner, P; Zanation, AM

Published Date

  • November 2010

Published In

Volume / Issue

  • 20 / 6

Start / End Page

  • 397 - 404

PubMed ID

  • 21772795

Pubmed Central ID

  • PMC3134819

Electronic International Standard Serial Number (EISSN)

  • 1532-0065

Digital Object Identifier (DOI)

  • 10.1055/s-0030-1253573


  • eng

Conference Location

  • United States