Efficacy of Simultaneous Pericranial and Nasoseptal “Double Flap” Reconstruction of Anterior Skull Base Defects after Combined Transbasal and Endoscopic Endonasal Approaches

Background: The vascularized pedicled pericranial flap (PCF) has been the traditional method of reconstruction of skull base defects after craniofacial resection of malignant anterior skull base (ASB) lesions. However, flap necrosis and cerebrospinal fluid (CSF) leaks can occur after radiation therapy. The “double flap” reconstruction technique was developed to augment the PCF inferiorly by a secondary vascularized pedicled nasoseptal flap (NSF) that is harvested using an endoscopic endonasal approach (EEA), when a combined cranionasal (transbasal EEA) approach is performed. This study examines the rates of postoperative CSF leaks and flap necrosis after a combined PCF and NSF closure of the skull base defect.

Methods: We conducted a retrospective review on nine consecutive patients, who underwent the double flap reconstruction technique after a combined transbasal-EEA approach. Data collected for each patient included demographics, method of tumor resection and repair, complications, tumor recurrence, and follow-up.

Results: Nine patients who underwent a combined transbasal and (EEA) for resection of anterior skull base tumors with significant intracranial extension followed by reconstruction of the cranial base using the double flap were identified. Four were men and five were women, with a mean age of 49 years (range: 15–68 years). There was no postoperative CSF leakage detected or complications of infection, meningitis, mucocele or tension pneumocephalus after a mean follow-up of 15.1 months (range: 4.6–35.4 months). Eight of the nine patients underwent adjuvant radiation without flap necrosis. Tumor recurrence was not observed in any of the patients at last follow-up.

Conclusion: The simultaneous PCF and NSF double flap reconstruction is an effective technique in preventing postoperative CSF leakage and postradiation necrosis when repairing anterior skull base defects after combined transbasal-EEA approaches.