1. Novel Surgical Treatment of Recurrent CSF Leak by Temporoparietal Temporalis Myofascial Flap: A Series of 6 Cases
- Author
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Shahzada Ahmed, Thomas Land, Alessandro Paluzzi, Georgios Tsermoulas, and Khandkar Ali Kawsar
- Subjects
Adult ,Male ,Natural Orifice Endoscopic Surgery ,medicine.medical_specialty ,Leak ,First line ,Temporal Muscle ,Skull Base Neoplasms ,Surgical Flaps ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Cerebrospinal fluid ,Recurrence ,medicine ,Humans ,Fascia ,Surgical treatment ,Anterior skull base ,High rate ,Cerebrospinal Fluid Leak ,business.industry ,Pedicled Flap ,Middle Aged ,eye diseases ,Surgery ,Skull ,Treatment Outcome ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Neuroendoscopy ,Female ,Radiotherapy, Adjuvant ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Background With the advent of modern endoscopes and a better anatomic understanding of the skull base, the indications of endonasal approaches are increasing. These procedures may be complicated by high rates of postoperative cerebrospinal fluid (CSF) leak, and reconstruction of the defect remains challenging. In the anterior skull base, vascularized grafts have been reported as superior in preventing CSF leakage and infection. The Hadad-Bassagasteguy flap, being a pedicled flap, is our first line flap to reconstruct the skull base. When we were not successful with this flap, we resorted to different flaps. Objective We modified the originally described temporoparietal fascial flap by Fortes et al and applied clinically. The objective of this paper is to briefly describe the modification of the flap and to review the clinical outcome. Methods From 2014 to 2018, in 6 cases of CSF leak with the appropriate indication, we used the temporoparietal myofascial flap repair that is a modification of the temporoparietal fascial flap by Fortes et al. We took all the 6 patients in our study and followed them up. Results All of the 6 repairs were successful, and no CSF leak was found just after the operation in 6- to 48-month follow-up. Conclusion We recommend our modified novel temporoparietal myofascial flap as a very good option in case of failed cases of postoperative CSF leak.
- Published
- 2021