J Neurol Surg B
DOI: 10.1055/s-0039-1695001
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Pedicle Corridors and Vessel Options for Free Flap Reconstruction following Endoscopic Endonasal Skull Base Surgery: A Systematic Review

1  Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, Saint Louis, Missouri, United States
,
Lauren T. Roland
2  Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, United States
3  Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, United States
,
Jeffrey D. Sharon
3  Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, United States
,
Michelle Doering
4  Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri, United States
,
Michael R. Chicoine
5  Department of Neurosurgery, Washington University in St Louis, Saint Louis, Missouri, United States
,
Patrik Pipkorn
1  Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, Saint Louis, Missouri, United States
› Author Affiliations
Further Information

Publication History

19 March 2019

03 July 2019

Publication Date:
12 September 2019 (online)

Abstract

Introduction Microvascular free flaps offer an alternative to local and regional flaps for coverage of complex or large skull base defects. Routes and approaches to these reconstructive options are complicated and require an understanding of complex head and neck anatomy.

Methods A systematic review of the literature was performed using a set of search terms with the help of a qualified librarian. Articles were reviewed and selected for inclusion based on relevance. We were interested in reporting possible routes for free flap accessibility to the skull base as well as microvascular vessel options, as this choice may affect the geometry and accessibility to the defect.

Results A total of 1,917 articles were obtained from a comprehensive search and 11 articles were ultimately found to be relevant to this review. Published options for vessel anastomosis and corridors to the skull base following endoscopic endonasal surgery are reviewed, including Caldwell-Luc/transbuccal space, prevertebral space, transpterygoid/parapharyngeal, and transmaxillary approaches.

Conclusion The field of endoscopic surgery has continued to advance and provide options for tumors of the skull base. This has led to a need for creative routes to the skull base for free flap reconstruction.