Techniques and Key Points for Endoscopic Cranial Base Reconstruction E-Book

Carlos Pinheiro-Neto

• Herausgeber: Thieme Medical Publishers
• Kategorie: Fachliteratur
• Sprache: Englisch

Veröffentlichungsjahr: 2022

Beschreibung

The quintessential guide to endoscopic skull base reconstruction from multidisciplinary experts

Due to close collaboration between otorhinolaryngologists and neurosurgeons, endoscopic endonasal brain surgery has become part of the surgical armamentarium for successful treatment of various cranial base pathologies. Today, it is considered the gold standard surgical technique for many types of skull base tumors. Techniques and Key Points for Endoscopic Cranial Base Reconstruction by pioneering otorhinolaryngologist Carlos D. Pinheiro-Neto and neurosurgeon Maria Peris-Celda, co-editor of Thieme's acclaimed Rhoton's Atlas of Head, Neck, and Brain, encompasses the most important endoscopic cranial base reconstruction techniques performed in the last two decades. The book features contributions from an impressive group of additional experts in this field.

Comprised of 26 reader-friendly chapters divided into seven sections, the book starts with discussion of general principles of endoscopic cranial base reconstruction. Sections II through VI provide step-by-step descriptions of reconstructive approaches utilizing diverse flaps including nasoseptal, intranasal, extranasal, and free grafts, followed by free flaps. The final section details management of seven challenging cases that enrich practical clinical experience, from free flap reconstruction to recalcitrant cerebrospinal fluid leak.

Key Highlights

• Decision-making rationales and pearls regarding selection of the most efficacious reconstructive techniques.
• Consistently formatted chapters feature a succinct review of anatomical concepts integral to each procedure, detailed descriptions for each surgical step, and alternative options.
• High-quality and meticulous anatomical dissections performed at the editors' anatomy laboratory and beautiful illustrations depict the flow of operations essential to understanding surgical nuances.
• Nineteen narrated videos visually demonstrate techniques and consolidate learning.

This must-have, comprehensive resource will help skull base surgeons master the latest techniques, avoid complications, and achieve improved outcomes for their patients.

This book includes complimentary access to a digital copy on https://medone.thieme.com.

Leseprobe

To access the additional media content available with this e-book via Thieme MedOne, please use the code and follow the instructions provided at the back of the e-book.

Techniques and Key Points for Endoscopic Cranial Base Reconstruction

Carlos D. Pinheiro-Neto, MD, PhDAssociate ProfessorDepartment of Otorhinolaryngology/Head and Neck SurgeryMayo ClinicRochester, Minnesota, USA

Maria Peris-Celda, MD, PhDAssociate ProfessorDepartment of NeurosurgeryMayo ClinicRochester, Minnesota, USA

250 illustrations

ThiemeNew York • Stuttgart • Delhi • Rio de Janeiro

Library of Congress Cataloging-in-Publication Data is available from the publisher

© 2022. Thieme. All rights reserved

Thieme Medical Publishers, Inc.

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[phone], [email protected]

Illustrations: Jennifer Pryll

Cover design: © Thieme

Cover images source: © Carlos D. Pinheiro-Neto and

Maria Peris-Celda

(© to all artwork in the book remains with the authors. All reproductions

of the artwork will need to have permission from the

authors to publish or use it in any form.)

Typesetting by DiTech Process Solutions, India

Printed in USA by King Printing Company, Inc. 5 4 3 2 1

ISBN: 978-1-68420-232-4

Also available as an e-book: eISBN: 978-1-68420-233-1 ePUB: 978-1-63853-701-4

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Tomy father, Dr. Sebastião Diógenes Pinheiro, for being an example of father, friend, physician, and professor. Thank you for showing me the fascinating world of the otorhinolaryngology and being the ultimate model of dedi1cation to the patients.

To my mother, Erineide, for the love, constant presence, and major efforts in my early education.

To my family for the unconditional love and support.

Carlos D. Pinheiro-Neto, MD, PhD

To my past, present, and future patients for the immense privilege to be involved in their care.

To those who donate their bodies for the study of anatomy and their families for their generosity that allows us to train, develop, and perfect new and safer surgical techniques.

To the memory of Professor A.L. Rhoton and his legacy to strive for more accurate, gentle, and safe surgeries.

Tomy beloved family, especiallymy parents Antonio and Maria, whose generosity and support are beyond comprehension.

Maria Peris-Celda, MD, PhD

Contents

Videos

Foreword

Preface

Acknowledgments

Contributors

Section I Introduction

1Principles of Endoscopic Cranial Base Reconstruction

Tyler Kenning, Laura Salgado-Lopez, Maria Peris-Celda, and Carlos D. Pinheiro-Neto

1.1Introduction

1.2Fundamentals of Endonasal Reconstruction

1.3Repair Options

1.4Vascularized Reconstruction

1.5Reconstruction Decalogue

2Operative Planning and Treatment Algorithm

Serdar Aydin, Carlos D. Pinheiro-Neto, and Maria Peris-Celda

2.1Introduction

2.2Preoperative Planning

2.3Perioperative and Intraoperative Considerations

2.4Treatment Algorithm

2.5Postoperative Considerations

2.5.1Inpatient Care

2.5.2Outpatient Care

Section II Nasoseptal Flap and Variations

3Standard Nasoseptal Flap

Carlos D. Pinheiro-Neto, Luciano C. P. C. Leonel, Natalia C. Rezende, and Maria Peris-Celda

3.1Anatomy

3.2Fundamentals

3.3Indications

3.4Limitations

3.5Surgical Technique (Videos 3.1 and 3.2)

3.5.1Harvest

3.5.2Reconstruction

3.6Postoperative Care

3.7Managing Complications

4Rescue Nasoseptal Flap

Carlos D. Pinheiro-Neto, Luciano C. P. C. Leonel, and Maria Peris-Celda

4.1Fundamentals

4.2Indications

4.3Limitations

4.4Surgical Technique (Video 4.1)

4.5Postoperative Care

4.6Complications

5Extended Nasoseptal Flap

Carlos D. Pinheiro-Neto, Luciano C. P. C. Leonel, and Maria Peris-Celda

5.1Fundamentals

5.2Indications

5.3Limitations

5.4Surgical Technique (Video 5.1)

5.4.1Harvest

5.4.2Reconstruction

5.5Postoperative Care

5.5.1One-Week Postoperative Visit

5.5.2One-Month Postoperative Visit

5.5.3Four-Month Postoperative Visit

5.6Complications

6Nasoseptal Flap Pedicle Release

Carlos D. Pinheiro-Neto, Luciano C. P. C. Leonel, and Maria Peris-Celda

6.1Anatomy

6.2Fundamentals

6.3Indications

6.4Limitations

6.5Surgical Technique (Videos 6.1 and 6.2)

6.5.1360-Degree Bone Removal around the SPA Foramen (Osseous Release)

6.5.2Ipsilateral Transpterygoid Approach

6.5.3360-Degree Circumferential Incision in the Periosteum of the PPF around the SPA (Periosteal Release)

6.6Postoperative Care

6.6.1One-Week Postoperative Visit

6.6.2One-Month Postoperative Visit

6.7Complications

7Composite Cartilagomucosal Nasoseptal Flap

Carlos D. Pinheiro-Neto, Luciano C. P. C. Leonel, and Maria Peris-Celda

7.1Fundamentals

7.2Indications

7.3Limitations

7.4Surgical Technique (Video 7.1)

7.4.1Flap Harvest

7.4.2Reconstruction

7.5Postoperative Care

7.6Complications

8Resurface of the Septum Donor Site

Carlos D. Pinheiro-Neto and Maria Peris-Celda

8.1Fundamentals

8.2Indications

8.3Limitations

8.3.1Reverse Contralateral NSF

8.3.2Inferior Meatal Flap

8.4Surgical Technique

8.4.1Reverse Contralateral NSF

8.4.2Inferior Meatal Flap (Video 8.1)

8.5Postoperative Care

8.6Complications

8.7Free Mucosal Grafts

Section III Other Intranasal Flaps

9Middle Turbinate Flap

Carlos D. Pinheiro-Neto, Luciano C. P. C. Leonel, and Maria Peris-Celda

9.1Anatomy

9.2Fundamentals

9.3Indications

9.4Limitations

9.5Surgical Technique

9.5.1Harvest

9.5.2Reconstruction

9.6Postoperative Care

9.7Complications

10Posterior-Based Lateral Nasal Wall Flaps

Carl H. Snyderman and Paul A. Gardner

10.1Anatomy

10.2Fundamentals

10.3Indications

10.4Limitations

10.5Surgical Technique

10.5.1Standard Posterior LNWF ▶ [60] (Videos 10.1 and 10.2)

10.5.2Extended Posterior LNWF

10.5.3Extended Posterior LNWF with Nasal Septum

10.6Postoperative Care

10.7Complications

11Anterior-Based Lateral Nasal Wall Flaps

Carlos D. Pinheiro-Neto, Luciano C. P. C. Leonel, and Maria Peris-Celda

11.1Anatomy

11.2Fundamentals

11.3Indications

11.4Limitations

11.5Surgical Technique

11.5.1Harvest (Video 11.1)

11.5.2Reconstruction

11.6Postoperative Care

11.7Complications

Section IV Extranasal Flaps

12Pericranial Flap

Laura Salgado-Lopez, Maria Peris-Celda, and Carlos D. Pinheiro-Neto

12.1Anatomy

12.2Fundamentals

12.3Indications

12.4Limitations

12.5Surgical Technique

12.5.1Pericranial Flap Harvest via Coronal Approach

12.5.2Pericranial Flap Harvest via Endoscopic Approach

12.6Postoperative Care

12.7Complications

13Temporoparietal Fascia Flap

Carlos D. Pinheiro-Neto, Luciano C. P. C. Leonel, and Felipe S. G. Fortes

13.1Anatomy

13.2Fundamentals

13.3Indications

13.4Limitations

13.5Surgical Technique

13.5.1Endoscopic Infratemporal Fossa Approach

13.5.2Temporoparietal Fascia Flap Harvest and Transposition

13.5.3Reconstruction

13.6Postoperative Care

13.7Complications

14Composite Extranasal Flaps: Osteopericranial and Osteotemporoparietal Fascia Flaps

Carlos D. Pinheiro-Neto and Maria Peris-Celda

14.1Anatomy

14.2Fundamentals

14.3Indications

14.4Limitations

14.5Surgical Technique

14.5.1Harvest

14.5.2Reconstruction

14.6Postoperative Care

14.7Complications

15Temporalis Muscle Flap

Roberto M. Soriano and C. Arturo Solares

15.1Anatomy

15.2Fundamentals

15.3Indications

15.4Limitations

15.5Surgical Technique

15.5.1Widening of Pterygoid Passage

15.5.2Temporalis Muscle Flap Harvest

15.5.3Flap Transposition and Inset

15.6Postoperative Care

15.7Complications

16Other Extranasal Flaps: Facial Artery Buccinator Flap and Palatal Flap

Garret W. Choby

16.1Anatomy

16.2Fundamentals

16.3Indications

16.4Limitations

16.5Surgical Technique

16.6Postoperative Care

16.7Complications

Section V Free Grafts

17Mucosal Grafts

Ramón Moreno-Luna, Maria Peris-Celda, and Carlos D. Pinheiro-Neto

17.1Fundamentals

17.2Indications

17.3Limitations

17.4Surgical Technique

17.4.1Nasal Floor Free Mucosal Graft (Videos 17.1 and 17.2)

17.4.2Middle Turbinate Free Mucosal Graft

17.4.3Nasal Septum Free Mucosal Graft

17.4.4Inferior Turbinate Free Mucosal Graft

17.4.5Lateral Nasal Wall Free Mucosal Graft (Anterior)

17.5Postoperative Care

17.6Complications

17.6.1Nasal Floor Free Mucosal Graft

17.6.2Middle Turbinate Free Mucosal Graft

17.6.3Nasal Septum Free Mucosal Graft

17.6.4Inferior Turbinate Free Mucosal Graft

17.6.5Lateral Nasal Wall Free Mucosal Graft (Anterior)

18Nonmucosal Grafts: Fat, Muscle, Fascia Lata, and Septal Cartilage

Laura Salgado-Lopez, Maria Peris-Celda, and Carlos D. Pinheiro-Neto

18.1Anatomy

18.2Fundamentals

18.3Indications

18.4Limitations

18.5Surgical Technique

18.6Postoperative Care

18.7Complications

Section VI Free Flaps

19Endoscopic Cranial Base Free Flap Reconstruction

Akina Tamaki, Abdulaziz Alrasheed, Daniel Prevedello, Enver Ozer, Ricardo L. Carrau, and Stephen Y. Kang

19.1Anatomy

19.2Fundamentals

19.3Indications

19.4Limitations

19.5Surgical Technique (Video 19.1)

19.5.1Preparation of Recipient Site

19.5.2Free Flap Harvest

19.5.3Free Flap Inset

19.6Postoperative Care

19.7Complications

Section VII Challenging Cases

20Free Flap Reconstruction

Adedamola Adepoju, Courtney Carpenter, Maria Peris-Celda, and Carlos D. Pinheiro-Neto

20.1Case Description

20.1.1Presentation

20.1.2Surgical Procedure (Video 20.1)

20.1.3Postoperative Course

20.2Challenges

20.3Discussion

20.4Alternatives

20.5Conclusions

20.6Reference

21Galeal-Frontalis Muscle Flap

Adedamola Adepoju, Tyler Kenning, Maria Peris-Celda, and Carlos D. Pinheiro-Neto

21.1Case Description

21.1.1Presentation

21.1.2Surgical Procedure

21.1.3Postoperative Course

21.2Challenges

21.3Discussion

21.4Alternatives

21.5Conclusions

22Necrotic Pericranial Scalp Flap

Carl H. Snyderman and Paul A. Gardner

22.1Case Description

22.1.1Presentation

22.1.2Surgical Procedure

22.1.3Postoperative Course

22.2Challenges

22.3Discussion

22.4Alternatives

22.5Conclusions

23Necrotic Nasoseptal Flap

Carl H. Snyderman and Paul A. Gardner

23.1Case Description

23.1.1Presentation

23.1.2Surgical Procedure

23.1.3Postoperative Course

23.2Challenges

23.3Discussion

23.4Alternatives

23.5Conclusions

24What to Do When a Nasoseptal Flap Is Not Perfusing?

Jamie J. Van Gompel, Janalee Stokken, and Salomon Cohen Cohen

24.1Case Description

24.1.1Presentation

24.1.2Surgical Procedure

24.1.3Postoperative Course

24.2Challenges

24.3Discussion

24.4Alternatives

24.5Conclusion

25Persistent Subcutaneous/Epidural Pneumocephalus Following Skull Base Surgery

Michael J. Link, Maria Peris-Celda, and Garret W. Choby

25.1Case Description

25.1.1Presentation

25.1.2Surgical Procedure

25.1.3Postoperative Course

25.1.4Surgical Repair

25.2Challenges

25.3Discussion

25.4Alternatives

25.5Conclusions

26Recalcitrant Cerebrospinal Fluid Leak

Abdulaziz Alrasheed, Akina Tamaki, Daniel Prevedello, Stephen Y. Kang, Enver Ozer, Mathew Old, Nolan Seim, Amit Agrawal, and Ricardo L. Carrau

26.1Case Description

26.1.1Presentation

26.1.2Surgical Procedure (Video 26.1)

26.1.3Postoperative Course

26.2Challenges

26.3Discussion

26.4Alternatives

26.5Conclusion

Index

Videos

Video 3.1:

Nasoseptal flap harvest and inset for reconstruction after anterior cranial base resection.

Video 3.2:

Reconstruction of suprasellar defect after resection of craniopharyngioma using inlay–onlay fascia lata button graft and onlay nasoseptal flap.

Video 3.3:

Nasoseptal flap incision along the nasal dorsum mucosa using endoscopic microscissors.

Video 4.1:

Rescue flap incision during a transsphenoidal approach.

Video 5.1:

Extended nasoseptal flap.

Video 6.1:

Nasoseptal flap pedicle release into the pterygopalatine fossa and dissection of the maxillary artery.

Video 6.2:

Nasoseptal flap pedicle release for reconstruction after partial rhinectomy.

Video 7.1:

Composite cartilagomucosal nasoseptal flap for reconstruction of suprasellar defect.

Video 8.1:

Inferior meatal flap to resurface the septum donor site after harvest of nasoseptal flap.

Video 10.1:

Posterior-based lateral nasal wall flap.

Video 10.2:

Inferior turbinate/lateral nasal wall flap for reconstruction of clival osteoradionecrosis with exposed carotid stent and coil.

Video 11.1:

Anterior-based lateral nasal wall flap.

Video 15.1:

Anatomical dissection of temporalis muscle flap.

Video 17.1:

Nasal floor free mucosal graft for reconstruction of sellar defect after pituitary tumor resection.

Video 17.2:

Nasal floor free mucosal graft for repair of chronic post-traumatic CSF leak.

Video 18.1:

Preparation of the fascia lata button graft on the surgical back table and inset of the graft for reconstruction of suprasellar defect.

Video 19.1:

Vastus lateralis free tissue transfer for endoscopic reconstruction of anterior cranial base defect.

Video 20.1:

Endoscopic anterior cranial base reconstruction with vastus lateralis muscle free flap. Inset through a maxillotomy approach.

Video 26.1:

Endoscopic cranial base reconstruction with vastus lateralis muscle free flap. Inset through a retropharyngeal corridor.

Foreword

Endoscopic endonasal surgery has become the new paradigm for the management of a variety of neoplastic and non-neoplastic conditions of the cranial base. The techniques have been widely adopted by skull base surgeons across surgical disciplines. As skull base teams gain experience and ascend the learning curve, they are more able to address large and complex pathologies that need more robust reconstruction of dural defects.

The early years of endoscopic endonasal surgery were plagued by a high postoperative cerebrospinal fluid leak rate. The advent of the vascularized nasoseptal flap for reconstruction was a major advance, with a dramatic and sudden decrease in postoperative cerebrospinal fluid leak rates. The initial publication describing the Hadad- Bassagasteguy flap in 2006 continues to be one of the most highly cited papers in skull base surgery. Subsequent literature reviews have confirmed the benefit of vascularized reconstruction of skull base defects. Multiple variations and refinements of the nasoseptal flap have been introduced subsequently along with a greater appreciation for other vascularized flaps, both local and regional. The lateral nasal wall flap (inferior turbinate flap) and extracranial pericrapericranial flap are examples of local and regional flaps that were developed to provide a reconstructive alternative when a nasoseptal flap is not available while minimizing morbidity.

Carlos D. Pinheiro-Neto and Maria Peris-Celda have succeeded in bringing together all the reconstructive techniques that are needed by the modern skull base surgeon, whether they are doing an open or endoscopic or combined approach. The chapters are organized in a succinct bulleted format that highlights essential information efficiently but still captures nuanced description of surgical technique. This format is optimal for quick reference and most conducive to learning. The chapters are lavishly illustrated with superb anatomical dissections using fully injected specimens from the laboratory of Pinheiro-Neto and Celda. The drawings are beautifully rendered and provide clear illustrations of reconstructive concepts. An added feature of this book is inclusion of challenging cases that anticipate the complications and reconstructive dilemmas bornout of experience. This textbook is an essential addition to the bookshelf of every skull base surgeon.

Carl Snyderman, MD, MBA

Foreword

In the past two decades, endoscopic endonasal cranial base surgery has become part of the surgical armamentarium to successfully treat a variety of cranial base pathologies. Currently, it is considered the gold standard surgical technique for many types of tumors. The evolution of a completely new surgical approach was only possible because of the close collaboration between otorhinolarygologists and neurosurgeons. A key limiting factor encountered early during this process was the high rates of postoperative cerebrospinal fluid (CSF) leak. In 2006, Gustavo Hadad and Luis Bassagasteguy from Argentina in association with Ricardo Carrau, Amin Kassam, and Carl Snyderman from the University of Pittsburgh published the first vascularized flap for endoscopic cranial base reconstruction. The nasoseptal flap revolutionized the field and allowed further advance in endoscopic skull base surgery, decreasing dramatically the postoperative CSF leak rates. Since then, numerous other flaps and modifications of techniques in endoscopic cranial base reconstruction have been published in the literature.

This project aims to compile in a unique book the most important endoscopic reconstructive surgical techniques published in the past two decades. This book is composed of 26 chapters divided into 7 sections. Section I provides an overviewof general principles to be followed in endoscopic cranial base reconstruction and resources to help decide the best technique for each type of skull base defect. Sections II to VI provide descriptions of each surgical technique, stepby- step, in a bullet format to make the reading more productive and to the point. Each chapter starts with a brief review of the important anatomical concepts for the surgical technique. Every nuance of each surgical step is described in detail and alternatives are provided. The surgical description is enriched with high-quality pictures and drawings illustrating the steps of the operation. Narrated videos are provided to demonstrate the technique and consolidate the learning. After reviewing the most important surgical techniques currently available for cranial base reconstruction, the reader will be able to acquire some practical clinical experience from difficult clinical examples in Section VII. This final section provides description of seven challenging cases managed by different and experienced skull base teams.

We hope this work serves as a practical reconstructive resource to the endoscopic skull base surgeon.

Carlos D. Pinheiro-Neto, MD, PhD Maria Peris-Celda, MD, PhD

Acknowledgments

We are indebted to Jennifer Pryll for her effort and dedication to performillustrations that make complex techniques easier to understand.

Wewould like to thank Shipra Sehgal and the rest of the Thieme team for their dedication and commitment to the publication of this book.

Carlos D. Pinheiro-Neto, MD, PhD Maria Peris-Celda, MD, PhD

Contributors

Adedamola Adepoju, MD

Neurosurgeon

Department of Neurosurgery

CHI St. Vincent Arkansa Neuroscience Institute

Sherwood, Arkansas, USA

Amit Agrawal, MD

Associate Professor

Department of Otolaryngology – Head and Neck Surgery

The James Cancer Hospital and Solove Research Institute

The Ohio State University Wexner Medical Center

Columbus, Ohio, USA

Abdulaziz Alrasheed, MD

Clinical Fellow

Department of Otolaryngology – Head and Neck Surgery

The James Cancer Hospital and Solove Research Institute

The Ohio State University Wexner Medical Center

Columbus, Ohio, USA

Serdar Aydin, MD

Research Fellow

Department of Neurosurgery, Albany Medical Center

Albany, New York, USA

Courtney Carpenter, MD

Assistant Professor of Plastic Surgery

Albany Medical Center

Albany, New York, USA

Ricardo L. Carrau, MD, MBA

Professor

Department of Otolaryngology – Head and Neck Surgery;

Lynne Shepard Jones Chair in Head and Neck Oncology;

Director of the Comprehensive Skull Base Surgery Program

The Ohio State University Medical Center;

Co-Director

Anatomy Laboratory Toward Visuospatial Surgical

Innovations in Otolaryngology and Neurosurgery

(ALT-VISION)

The Ohio State University Wexner Medical Center

Columbus, Ohio, USA

Garret W. Choby, MD

Associate Professor

Rhinology and Skull Base Surgery;

Chair of Quality

Department of Otolaryngology – Head and Neck Surgery,

Joint Appointment

Department of Neurologic Surgery

Mayo Clinic

Rochester, Minnesota, USA

Salomon Cohen Cohen, MD

Resident

Department of Neurosurgery

Mayo Clinic

Rochester, Minnesota, USA

Felipe S. G. Fortes, MD, PhD

Otolaryngologist and Facial Plastic Surgeon, Clinica Fortes

São Paulo, Brazil

Paul A. Gardner, MD

Professor and Peter J. Janetta Endowed Chair

Department of Neurological Surgery

University of Pittsburgh School of Medicine;

Co-Director

Center for Cranial Base Surgery

University of Pittsburgh Medical Center

Pittsburgh, Pennsylvania, USA

Stephen Y. Kang, MD

Head and Neck Surgeon

Department of Otolaryngology – Head and Neck Surgery

The James Cancer Hospital and Solove Research Institute

The Ohio State University Wexner Medical Center

Columbus, Ohio, USA

Tyler Kenning, MD

Neurosurgeon

Piedmont Heathcare

Atlanta, Georgia, USA

Luciano C. P. C. Leonel, PhD

Research Fellow

Department of Neurosurgery

Mayo Clinic

Rochester, Minnesota, USA

Michael J. Link, MD

Professor

Departments of Neurologic Surgery and

Otorhinolaryngology

Mayo Clinic

Rochester, Minnesota, USA

Ramon Moreno-Luna, MD, PhD

Otolaryngologist

Rhinology and Skull Base Unit

University Hospital Virgen de la Macarena

Seville, Spain

Mathew Old, MD

Associate Professor

Department of Otolaryngology – Head and Neck Surgery

The James Cancer Hospital and Solove Research Institute

The Ohio State University Wexner Medical Center

Columbus, Ohio, USA

Enver Ozer, MD

Professor

Department of Otolaryngology – Head and Neck Surgery

Wexner Medical Center

The James Cancer Hospital and Solove Research Institute,

The Ohio State University

Columbus, Ohio, USA

Maria Peris-Celda, MD, PhD

Associate Professor

Department of Neurosurgery

Mayo Clinic

Rochester, Minnesota, USA

Carlos D. Pinheiro-Neto, MD, PhD

Associate Professor

Department of Otorhinolaryngology/Head and Neck

Surgery

Mayo Clinic

Rochester, Minnesota, USA

Daniel Prevedello, MD

Professor

Department of Neurological Surgery

The James Cancer Hospital and Solove Research Institute

The Ohio State University Wexner Medical Center

Columbus, Ohio, USA

Natalia C. Rezende, MD

Research Fellow

Department of Neurosurgery

Mayo Clinic

Rochester, Minnesota, USA

Laura Salgado-Lopez, MD

Research Fellow

Department of Neurosurgery

Mount Sinai Hospital

New York, New York, USA

Nolan Seim, MD

Assistant Professor

Department of Otolaryngology – Head and Neck Surgery

The James Cancer Hospital and Solove Research Institute

The Ohio State University Wexner Medical Center

Columbus, Ohio, USA

Carl H. Snyderman, MD, MBA

Professor

Department of Otolaryngology

University of Pittsburgh School of Medicine;

Co-Director

Center for Cranial Base Surgery

University of Pittsburgh Medical Center

Pittsburgh, Pennsylvania, USA

C. Arturo Solares, MD, FACS, MD, FACS

Professor of Otolaryngology and Neurosurgery;

Director, Skull Base Surgery

Emory University

Atlanta, Georgia, USA

Roberto M. Soriano, MD

Research Fellow

Department of Otolaryngology – Head and Neck Surgery

Emory University

Atlanta, Georgia, USA

Janalee Stokken, MD

Associate Professor

Department of Otolaryngology – Head and Neck Surgery

Mayo Clinic

Rochester, Minnesota, USA

Akina Tamaki, MD

Assistant Professor

Department of Otolaryngology

Case Western Reserve University

University Hospitals Cleveland Medical Center

Cleveland, Ohio, USA

Jamie J. Van Gompel, MD, FAANS

Professor in Neurosurgery and Otorhinolaryngology;

Program Director

International Neurosurgery Fellowship;

Associate Program Director

Neurosurgical Skull Base Oncology Fellowship

Mayo Clinic

Rochester, Minnesota, USA

Section I

Introduction

1 Principles of Endoscopic Cranial Base Reconstruction

2 Operative Planning and Treatment Algorithm

1 Principles of Endoscopic Cranial Base Reconstruction

Tyler Kenning, Laura Salgado-Lopez, Maria Peris-Celda, and Carlos D. Pinheiro-Neto

1.1 Introduction

Endonasal approaches to the cranial base have not only permitted access to an increasingly vast range of pathology but have also brought new surgical challenges.

Reconstruction after cranial base surgery separates the sinonasal and intracranial compartments, preventing postoperative cerebrospinal fluid (CSF) fistulas, and limiting the morbidity and mortality.

The goals for repair of the cranial base include the elimination of dead space, providing structural support, contour and function of the cranial base, and protection and preservation of intracranial and orbital contents.

Beyond the need for reoperation and further repair, reconstruction failures have the potential for significant morbidity: meningitis, subdural hemorrhage, intracranial abscess, hydrocephalus, pneumocephalus, and even death. 1 Delayed complications include epistaxis, chronic rhinosinusitis, and sinonasal mucocele formation. 2