The Laryngoscope C 2013 The American Laryngological, V
Rhinological and Otological Society, Inc.
Letter to the Editor
In Reference to Simultaneous Pericranial and Nasoseptal Flap Reconstruction of Anterior Skull Base Defects Following Endoscopic-Assisted Craniofacial Resection
Dear Editor, We read with interest the article by Chaaban et al. titled “Simultaneous Pericranial and Nasoseptal Flap Reconstruction of Anterior Skull Base Defects Following Endoscopic-Assisted Craniofacial Resection” published in The Laryngoscope,1 and compliment the authors on their work. They described a technique for anterior skull base (ASB) defects reconstruction after combined open craniofacial resection with endoscopic assistance using simultaneous pericranial flaps (PCFs) and nasoseptal flaps (NSFs). In their article, the authors state that the utility of the NSF used in conjunction with a PCF following endoscopic-assisted craniofacial resection has not been previously investigated. However, this technique has been previously reported by our group at Rutgers New Jersey Medical School in the May 2013 issue of the International Forum of Allergy and Rhinology, in an article entitled “Double Flap Technique for Reconstruction of Anterior Skull Base Defects After Craniofacial Tumor Resection: Technical Note.”2 This article first appeared in PubMed ahead of print on October 4, 2012. In our article we described two patients who underwent a combined cranionasal (transbasal and endoscopic endonasal) approach for large sinonasal malignancies with significant intracranial extension. One patient had an esthesioneuroblastoma and the other patient had a sinonasal teratocarcinosarcoma. After tumor removal, the ASB defect was reconstructed with a double flap technique comprised of a vascularized pedicled PCF from above and augmented with a vascularized pedicled NSF from below. Postoperatively, there were no complications of cerebrospinal fluid (CSF) leakage, meningitis, or tension pneumocephalus.
Laryngoscope 124: April 2014
Both patients underwent radiation therapy without flap necrosis. We advocated this technique as a viable option in patients who undergo combined transcranial and transnasal endoscopic tumor resections where postoperative radiation therapy is anticipated, as in cases for skull base malignancies. In our article, we also discussed the importance of how both flaps complement each other at their respective points of weakness. For instance, in a PCF repair alone, the point of weakness that is most likely to leak is the region of the planum sphenoidale at the posterior suture line. This region can be supplemented with coverage by a robust NSF. Similarly, the point of weakness for potential CSF leak in a NSF repair alone is anteriorly near the region of the frontal sinus due to maximal reach. This region is nicely reinforced with a PCF from above. The combined PCF and NSF repair provides complementary vascularized tissue to prevent postoperative CSF leakage and flap necrosis after radiation therapy.2 JEAN ANDERSON ELOY, MD, FACS JAMES K. LIU, MD Department of Otolaryngology–Head and Neck Surgery Department of Neurological Surgery Center for Skull Base and Pituitary Surgery Rutgers New Jersey Medical School Newark, New Jersey
BIBLIOGRAPHY 1. Chaaban MR, Chaudhry A, Riley KO, Woodworth BA. Simultaneous pericranial and nasoseptal flap reconstruction of anterior skull base defects following endoscopic-assisted craniofacial resection. Laryngoscope 2013; 123:2383–2386. 2. Eloy JA, Choudhry OJ, Christiano LD, Ajibade DV, Liu JK. Double flap technique for reconstruction of anterior skull base defects after craniofacial tumor resection: technical note. Int Forum Allergy Rhinol 2013;3: 425–430.
Eloy and Liu: Letter to the Editor
E149
Rhinological and Otological Society, Inc.
Letter to the Editor
In Reference to Simultaneous Pericranial and Nasoseptal Flap Reconstruction of Anterior Skull Base Defects Following Endoscopic-Assisted Craniofacial Resection
Dear Editor, We read with interest the article by Chaaban et al. titled “Simultaneous Pericranial and Nasoseptal Flap Reconstruction of Anterior Skull Base Defects Following Endoscopic-Assisted Craniofacial Resection” published in The Laryngoscope,1 and compliment the authors on their work. They described a technique for anterior skull base (ASB) defects reconstruction after combined open craniofacial resection with endoscopic assistance using simultaneous pericranial flaps (PCFs) and nasoseptal flaps (NSFs). In their article, the authors state that the utility of the NSF used in conjunction with a PCF following endoscopic-assisted craniofacial resection has not been previously investigated. However, this technique has been previously reported by our group at Rutgers New Jersey Medical School in the May 2013 issue of the International Forum of Allergy and Rhinology, in an article entitled “Double Flap Technique for Reconstruction of Anterior Skull Base Defects After Craniofacial Tumor Resection: Technical Note.”2 This article first appeared in PubMed ahead of print on October 4, 2012. In our article we described two patients who underwent a combined cranionasal (transbasal and endoscopic endonasal) approach for large sinonasal malignancies with significant intracranial extension. One patient had an esthesioneuroblastoma and the other patient had a sinonasal teratocarcinosarcoma. After tumor removal, the ASB defect was reconstructed with a double flap technique comprised of a vascularized pedicled PCF from above and augmented with a vascularized pedicled NSF from below. Postoperatively, there were no complications of cerebrospinal fluid (CSF) leakage, meningitis, or tension pneumocephalus.
Laryngoscope 124: April 2014
Both patients underwent radiation therapy without flap necrosis. We advocated this technique as a viable option in patients who undergo combined transcranial and transnasal endoscopic tumor resections where postoperative radiation therapy is anticipated, as in cases for skull base malignancies. In our article, we also discussed the importance of how both flaps complement each other at their respective points of weakness. For instance, in a PCF repair alone, the point of weakness that is most likely to leak is the region of the planum sphenoidale at the posterior suture line. This region can be supplemented with coverage by a robust NSF. Similarly, the point of weakness for potential CSF leak in a NSF repair alone is anteriorly near the region of the frontal sinus due to maximal reach. This region is nicely reinforced with a PCF from above. The combined PCF and NSF repair provides complementary vascularized tissue to prevent postoperative CSF leakage and flap necrosis after radiation therapy.2 JEAN ANDERSON ELOY, MD, FACS JAMES K. LIU, MD Department of Otolaryngology–Head and Neck Surgery Department of Neurological Surgery Center for Skull Base and Pituitary Surgery Rutgers New Jersey Medical School Newark, New Jersey
BIBLIOGRAPHY 1. Chaaban MR, Chaudhry A, Riley KO, Woodworth BA. Simultaneous pericranial and nasoseptal flap reconstruction of anterior skull base defects following endoscopic-assisted craniofacial resection. Laryngoscope 2013; 123:2383–2386. 2. Eloy JA, Choudhry OJ, Christiano LD, Ajibade DV, Liu JK. Double flap technique for reconstruction of anterior skull base defects after craniofacial tumor resection: technical note. Int Forum Allergy Rhinol 2013;3: 425–430.
Eloy and Liu: Letter to the Editor
E149
