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CC BY-NC-ND 4.0 · J Neurol Surg Rep 2023; 84(03): e87-e91
DOI: 10.1055/s-0043-1772200
Original Report

Bilateral Inferior Turbinate Flaps for Salvage Reconstruction after Proton Beam Radiotherapy for Clival Chordoma

Kayva L. Crawford 
1   Department of Otolaryngology – Head & Neck Surgery, University of California San Diego, La Jolla, California, United States
,
Megana Saripella
2   School of Medicine, University of California San Diego, La Jolla, California, United States
,
Adam S. DeConde
1   Department of Otolaryngology – Head & Neck Surgery, University of California San Diego, La Jolla, California, United States
,
Thomas L. Beaumont
3   Department of Neurological Surgery, University of California San Diego, La Jolla, California, United States
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Abstract

Clival chordoma is a rare, aggressive, notochord-derived tumor primarily managed with surgery via an endoscopic endonasal approach (EEA) and adjuvant proton beam radiotherapy. Reconstruction is commonly performed with a nasoseptal flap (NSF) at the time of initial surgery. While failures of the NSF are rare, they can occur following the initial surgery or in the setting of osteoradionecrosis. Salvage repair typically requires transfer of alternative vascularized tissues outside of the previously radiated field including regional scalp flaps such as pericranial or temporoparietal fascial flaps, or free vascularized tissue transfer. Here we describe the case of a 29-year-old woman with a history of clival chordoma with widespread skull base osteomyelitis secondary to NSF necrosis after proton beam radiotherapy. We describe successful skull base reconstruction with intranasal bilateral inferior turbinate flaps based on the sphenopalatine artery with lateral nasal wall extension, despite prior proton beam therapy and a failed prior vascularized intranasal reconstruction.

Keywords

chordoma - inferior turbinate - flap - osteoradionecrosis - proton - radiotherapy


Publication History

Received: 08 February 2023

Accepted: 17 June 2023

Article published online:
11 August 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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