Minimally invasive pericranial flap harvest through a supraorbital eyebrow craniotomy: Technical note in salvage skull base reconstruction.

Publication Title

Clinical neurology and neurosurgery

Authors

Madeline G Olson, Pacific Neuroscience Institute, Santa Monica, CA, USAFollow
Michael B Avery, Pacific Neuroscience Institute, Santa Monica, CA, USA; Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USAFollow
Shauna Javaherian, Pacific Neuroscience Institute, Santa Monica, CA, USA
Walavan Sivakumar, Pacific Neuroscience Institute, Santa Monica, CA, USA; Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA; Little Company of Mary Medical Center, Torrance, CA, USAFollow
Daniel F Kelly, Pacific Neuroscience Institute, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USAFollow
Chester Griffiths, Pacific Neuroscience Institute, Santa Monica, CA, USA; Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USAFollow
Garni Barkhoudarian, Pacific Neuroscience Institute, Santa Monica, CA, USA; Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA. Electronic addressFollow

Document Type

Article

Publication Date

6-1-2022

Keywords

california; santa monica; pacific neurosci; Anterior cranial fossa; Cerebrospinal fluid leak; Minimally invasive; Pericranial flap; Skull base reconstruction; Supraorbital craniotomy; Adult; Craniotomy; Eyebrows; Female; Humans; Middle Aged; Reconstructive Surgical Procedures; Skull Base; Surgical Flaps

Abstract

BACKGROUND AND IMPORTANCE: The supraorbital eyebrow craniotomy is a minimally invasive approach that provides access to pathologies of the anterior and middle cranial fossae. Vascularized flaps are preferred when considering reconstructive options, however, small incisions may not provide adequate access to vascularized tissue. We present two cases demonstrating a modified technique for harvesting pericranium through an eyebrow supraorbital craniotomy for reconstruction of large skull base defects.

CLINICAL PRESENTATION: The first case is of a 62-year-old woman with an invasive esthesioneuroblastoma. Multiple resections and reconstructions, including a large frontal craniectomy and titanium mesh cranioplasty, resulted in refractory tension pneumocephalus. A supraorbital craniotomy was performed with endoscope-assisted harvesting of a pericranial flap through a coronal plane stab incision for definitive repair. The second case is a 44-year-old woman with a high-grade neuroendocrine tumor transgressing the anterior cranial fossa. Resection was achieved via combined supraorbital eyebrow craniotomy and endoscopic endonasal approach. A multilayered reconstruction including a pericranial flap from above and a nasoseptal flap from below was used to reconstruct the defect. The pericranial flap was again harvested with endoscope assistance through a coronal plane stab incision. Both cases had excellent outcomes with no post-operative cerebrospinal fluid leak.

CONCLUSION: Repair of large anterior cranial fossa defects with a vascularized pericranial flap can be performed through a supraorbital eyebrow craniotomy. Utilizing small, strategically placed transverse (coronal plane) incisions behind the hairline allows for the endoscope-assisted harvesting of a highly customized flap. This modified technique increases the flexibility of the minimally invasive supraorbital craniotomy.

Area of Special Interest

Neurosciences (Brain & Spine)

Specialty/Research Institute

Neurosciences