Microvascular Mapping in a Cadaveric Model: Implications for Endoscopic Skull Base Reconstruction

Objective: Endoscopic methods are being used for larger and varying locations in anterior skull base surgery. As a result, the resulting defects and their reconstruction can pose challenges. Being able to preoperatively map the sinonasal vasculature can help identify healthy tissue and their vascular pedicles for individualized reconstruction. Study Design and Methods: For this study the cadaveric tissue was used. Using modifications of previously described methods, we tested varying mixtures of latex, barium sulfate, and fluorescein in dilute formaldehyde to develop a stable method of vascular injection. Visualization of vessels was performed with CT imaging and dissection. The protocol was first tested on larger vessels to optimize infusion mixture and method. Perfusion was performed using a Preston varistaltic power pump. We infused the right and left carotid arteries of an intact cadaver to test perfusion of the vasculature. Results: CT and dissection revealed the following vessels: facial, nasal, occipital, maxillary, middle meningeal, temporal, middle cerebral, anterior cerebral, opthalmic, septal branches, and greater palatine. CT images provided a map of vessels supplying potential reconstructive flaps in specific anatomic areas. Vessels ranging from 0.580 to 6.421 mm could be mapped. Conclusions: Our method provided a reliable vascular map. Modified methods could guide reconstructive options in primary and revision endoscopic skull base surgery, where the vascular supply may have variations.