Temporal Galeofascial Flap for Reconstruction After Transmaxillary Approaches to the Clival Region

World Neurosurg. 2020 Feb;134:e68-e74. doi: 10.1016/j.wneu.2019.09.038. Epub 2019 Sep 14.

Abstract

Background: A paramount concern after transmaxillary approaches has been skull base reconstruction. Regional pedicled flaps represent the best reconstructive option. We have described a technique to harvest a lateral-based multilayered vascularized flap for skull base reconstruction after resection of large tumors using the transmaxillary transpterygoid approach (TMTPA).

Methods: We performed a cadaver study using the TMTPA to harvest the combined temporal galeofascial flap (CTGF). The first layer, with major sealing capabilities, is composed by a temporoparietal galeal-pericranial flap. The second layer is composed by temporal muscle fascia to provide mechanical support for flap dural engrafting.

Results: The CTGF provides excellent coverage of both the clival dural lining and the ipsilateral pterygopalatine fossa structures (×1.6). The CTGF is pliable and easy to harvest. It offers great flexibility in flap content and design, providing a large quantity of vascularized tissue. The vascular pedicle derives from the superficial temporal vessels, which can ensure flap trophism.

Conclusions: CTGF represents an effective option as a regional multilayered pedicled flap for skull base reconstruction after resection of clival tumors using the TMTPA. The flap pedicle, owing to its anatomical location, will often be preserved even after repeated microsurgical or endoscopic procedures, providing a technical alternative for reconstruction even in patients who have undergone multiple surgeries with low residual availability of regional flaps.

Keywords: Clivus; Galeal-pericranial flap; Skull base reconstruction; Temporal muscle fascia; Transmaxillary approaches.

MeSH terms

  • Adult
  • Cadaver
  • Cerebrospinal Fluid Leak / surgery
  • Cranial Fossa, Posterior / surgery*
  • Endoscopy / methods
  • Humans
  • Nasal Cavity / surgery
  • Reconstructive Surgical Procedures / methods
  • Skull Base / surgery*
  • Skull Base Neoplasms / surgery*
  • Surgical Flaps / surgery*