The V-Bridge Reconstruction Technique for Securing the Pericranial Flap in Combined Transbasal/Endoscopic Endonasal Approaches: Technical Note and Experience in Six Cases

Introduction: The transbasal approach provides wide access for intracranial anterior skull base pathologies that erode through the cribriform plate into the paranasal sinuses, which can often be combined with the endoscopic endonasal approach (EEA). After tumor resection, the resultant skull base cribriform defect can be quite large and pose considerable risk for postoperative CSF leakage and pneumocephalus. The vascularized pedicled pericranial flap is the workhorse for anterior skull base reconstruction by providing a barrier between the intracranial and paranasal sinus cavities. It is important to secure the flap so that there is no flap migration that can result in pneumocephalus or CSF leakage. We describe the V-bridge technique to secure the precranial flap to prevent such complications and report our results in 6 patients.

Methods: After anterior skull base tumor resection, the resultant transcribriform defect was reconstructed with a vascularized pericranial flap. The flap was secured to the orbital roofs using two to three V-shaped microfixation plates contoured in the shape of the anterior skull base. If bone was not present, a suture was used to secure the plate and flap to the periorbita in place of a screw.

Results: Six patients underwent the described V-bridge technique for reconstruction of the cribriform defect after ASB tumor resection. Five patients underwent a combined transbasal-EEA, and one underwent a pure transbasal approach. Pathologies included: 2 squamous cell carcinomas, 2 olfactory groove meningiomas, 1 esthesioneuroblastoma, and 1 mucoepidermoid carcinoma. None of the patients exhibited postoperative CSF leakage or tension pneumocephalus. One patient who did not initially have a V-bridge developed tension pneumocephalus due to ball-valve of the pericranial flap. The flap reconstruction was successfully revised and secured using a V-bridge technique which prevented any further pneumocephalus.

Conclusion: The V-bridge reconstruction is an effective technique for securing the pericranial flap for preventing flap migration associated with ball-valving tension pneumocephalus and postoperative CSF leakage after transbasal approaches for anterior skull base lesions.

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Artikel online veröffentlicht:
05. Februar 2024