Temporal myofascial segmentation for multilayer reconstruction of middle cranial fossa floor after extradural subtemporal approach to the clival and paraclival region

Head Neck. 2019 Oct;41(10):3631-3638. doi: 10.1002/hed.25896. Epub 2019 Aug 7.

Abstract

Background: Skull-base reconstruction represents a concern after resection of middle fossa (MF) tumors by the extradural subtemporal transzygomatic approach (ESTZ). Regional pedicled flaps appear to be the best option. This study describes a technique for temporal myofascial segmentation to harvest a multilayered vascularized flap for MF reconstruction, which might preserve temporal muscle (TM) function and its blood supply.

Methods: The technique to harvest a combined segmented temporal myofascial flap (CSTMF) is described. The flap consists in a temporal fascial (TFF) and a muscle flap (TMF), composed by TM anterior-medial bundle (AMB).

Results: CSTMF provides wide coverage of dural lining, through the TFF, and of dead-space, through the TMF. The possibility to tailor TMF according to the need, anatomically preserving the blood supply, enables to significantly increase its volume.

Conclusion: CSTMF represents an effective option as regional multilayered pedicled flap for MF reconstruction, potentially preserving TM function and minimizing the cosmetic impact.

Keywords: extradural subtemporal transzygomatic approach; pedicled flap; skull base reconstruction; temporal fascia flap; temporal muscle.

MeSH terms

  • Cohort Studies
  • Cranial Fossa, Middle / surgery*
  • Cranial Fossa, Posterior / surgery
  • Female
  • Follow-Up Studies
  • Graft Rejection
  • Graft Survival
  • Humans
  • Male
  • Middle Aged
  • Myocutaneous Flap / blood supply
  • Myocutaneous Flap / transplantation*
  • Reconstructive Surgical Procedures / methods*
  • Retrospective Studies
  • Risk Assessment
  • Skull Base Neoplasms / diagnostic imaging
  • Skull Base Neoplasms / mortality
  • Skull Base Neoplasms / surgery*
  • Surgical Flaps / blood supply
  • Surgical Flaps / transplantation*
  • Temporal Muscle / surgery
  • Tissue and Organ Harvesting
  • Treatment Outcome