Surgical anatomy and utility of pedicled vascularized tissue flaps for multilayered repair of skull base defects

Sam Safavi-Abbasi, Noritaka Komune, Jacob B. Archer, Hai Sun, Nicholas Theodore, Jeffrey Nelson James, Andrew S. Little, Peter Nakaji, Michael E. Sughrue, Albert L. Rhoton, Robert F. Spetzler

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

OBJECTIVE: The objective of this study was to describe the surgical anatomy and technical nuances of various vascularized tissue flaps. METHODS: The surgical anatomy of various tissue flaps and their vascular pedicles was studied in 5 colored silicone-injected anatomical specimens. Medical records were reviewed of 11 consecutive patients who underwent repair of extensive skull base defects with a combination of various vascularized flaps. RESULTS: The supraorbital, supratrochlear, superficial temporal, greater auricular, and occipital arteries contribute to the vascular supply of the pericranium. The pericranial flap can be designed based on an axial blood supply. Laterally, various flaps are supplied by the deep or superficial temporal arteries. The nasoseptal flap is a vascular pedicled flap based on the nasoseptal artery. Patients with extensive skull base defects can undergo effective repair with dual flaps or triple flaps using these pedicled vascularized flaps. CONCLUSIONS: Multiple pedicled flaps are available for reconstitution of the skull base. Knowledge of the surgical anatomy of these flaps is crucial for the skull base surgeon. These vascularized tissue flaps can be used effectively as single or combination flaps. Multilayered closure of cranial base defects with vascularized tissue can be used safely and may lead to excellent repair outcomes.

Original languageEnglish (US)
Pages (from-to)419-430
Number of pages12
JournalJournal of neurosurgery
Volume125
Issue number2
DOIs
StatePublished - Aug 1 2016

Fingerprint

Skull Base
Surgical Flaps
Anatomy
Blood Vessels
Arteries
Temporal Arteries
Silicones
Medical Records

Keywords

  • Cerebrospinal fluid leak
  • Skull base fractures
  • Skull base reconstruction
  • Surgical technique
  • Temporoparietal fascia

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Surgical anatomy and utility of pedicled vascularized tissue flaps for multilayered repair of skull base defects. / Safavi-Abbasi, Sam; Komune, Noritaka; Archer, Jacob B.; Sun, Hai; Theodore, Nicholas; James, Jeffrey Nelson; Little, Andrew S.; Nakaji, Peter; Sughrue, Michael E.; Rhoton, Albert L.; Spetzler, Robert F.

In: Journal of neurosurgery, Vol. 125, No. 2, 01.08.2016, p. 419-430.

Research output: Contribution to journalArticle

Safavi-Abbasi, S, Komune, N, Archer, JB, Sun, H, Theodore, N, James, JN, Little, AS, Nakaji, P, Sughrue, ME, Rhoton, AL & Spetzler, RF 2016, 'Surgical anatomy and utility of pedicled vascularized tissue flaps for multilayered repair of skull base defects', Journal of neurosurgery, vol. 125, no. 2, pp. 419-430. https://doi.org/10.3171/2015.5.JNS15529
Safavi-Abbasi, Sam ; Komune, Noritaka ; Archer, Jacob B. ; Sun, Hai ; Theodore, Nicholas ; James, Jeffrey Nelson ; Little, Andrew S. ; Nakaji, Peter ; Sughrue, Michael E. ; Rhoton, Albert L. ; Spetzler, Robert F. / Surgical anatomy and utility of pedicled vascularized tissue flaps for multilayered repair of skull base defects. In: Journal of neurosurgery. 2016 ; Vol. 125, No. 2. pp. 419-430.
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abstract = "OBJECTIVE: The objective of this study was to describe the surgical anatomy and technical nuances of various vascularized tissue flaps. METHODS: The surgical anatomy of various tissue flaps and their vascular pedicles was studied in 5 colored silicone-injected anatomical specimens. Medical records were reviewed of 11 consecutive patients who underwent repair of extensive skull base defects with a combination of various vascularized flaps. RESULTS: The supraorbital, supratrochlear, superficial temporal, greater auricular, and occipital arteries contribute to the vascular supply of the pericranium. The pericranial flap can be designed based on an axial blood supply. Laterally, various flaps are supplied by the deep or superficial temporal arteries. The nasoseptal flap is a vascular pedicled flap based on the nasoseptal artery. Patients with extensive skull base defects can undergo effective repair with dual flaps or triple flaps using these pedicled vascularized flaps. CONCLUSIONS: Multiple pedicled flaps are available for reconstitution of the skull base. Knowledge of the surgical anatomy of these flaps is crucial for the skull base surgeon. These vascularized tissue flaps can be used effectively as single or combination flaps. Multilayered closure of cranial base defects with vascularized tissue can be used safely and may lead to excellent repair outcomes.",
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AU - James, Jeffrey Nelson

AU - Little, Andrew S.

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