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

Publication ,  Journal Article
Patel, MR; Stadler, ME; Snyderman, CH; Carrau, RL; Kassam, AB; Germanwala, AV; Gardner, P; Zanation, AM
Published in: Skull Base
November 2010

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.

Duke Scholars

Published In

Skull Base

DOI

EISSN

1532-0065

Publication Date

November 2010

Volume

20

Issue

6

Start / End Page

397 / 404

Location

United States

Related Subject Headings

  • Neurology & Neurosurgery
  • 3203 Dentistry
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Patel, M. R., Stadler, M. E., Snyderman, C. H., Carrau, R. L., Kassam, A. B., Germanwala, A. V., … Zanation, A. M. (2010). How to choose? Endoscopic skull base reconstructive options and limitations. Skull Base, 20(6), 397–404. https://doi.org/10.1055/s-0030-1253573
Patel, Mihir R., Michael E. Stadler, Carl H. Snyderman, Ricardo L. Carrau, Amin B. Kassam, Anand V. Germanwala, Paul Gardner, and Adam M. Zanation. “How to choose? Endoscopic skull base reconstructive options and limitations.Skull Base 20, no. 6 (November 2010): 397–404. https://doi.org/10.1055/s-0030-1253573.
Patel MR, Stadler ME, Snyderman CH, Carrau RL, Kassam AB, Germanwala AV, et al. How to choose? Endoscopic skull base reconstructive options and limitations. Skull Base. 2010 Nov;20(6):397–404.
Patel, Mihir R., et al. “How to choose? Endoscopic skull base reconstructive options and limitations.Skull Base, vol. 20, no. 6, Nov. 2010, pp. 397–404. Pubmed, doi:10.1055/s-0030-1253573.
Patel MR, Stadler ME, Snyderman CH, Carrau RL, Kassam AB, Germanwala AV, Gardner P, Zanation AM. How to choose? Endoscopic skull base reconstructive options and limitations. Skull Base. 2010 Nov;20(6):397–404.

Published In

Skull Base

DOI

EISSN

1532-0065

Publication Date

November 2010

Volume

20

Issue

6

Start / End Page

397 / 404

Location

United States

Related Subject Headings

  • Neurology & Neurosurgery
  • 3203 Dentistry
  • 1103 Clinical Sciences