title: Pericranial flap for endoscopic anterior skull-base reconstruction: clinical outcomes and radioanatomic analysis of preoperative planning.
abstract: BACKGROUND
  One of the major challenges of cranial base surgery is reconstruction of the dural defect and prevention of postoperative cerebrospinal fluid (CSF) fistula. The introduction of endoscopic techniques and an endonasal approach to the ventral skull base has created new challenges for reconstruction.
  
  
  OBJECTIVE
  We have developed an endoscopic pericranial flap (PCF) for skull base reconstruction and hereby present the initial cohort of patients who had endonasal reconstruction with a PCF after endoscopic skull base resection. We also demonstrate a method to radiographically incorporate anticipated skull base defects for preoperative planning of PCF length.
  
  
  METHODS
  Dural defects after endonasal skull base resection of invasive tumors were reconstructed with an onlay PCF (n = 10). We performed radiological studies to assist preoperative planning for where to make incisions while harvesting a PCF for anterior skull base, sellar, and clival defects.
  
  
  RESULTS
  Each of the 10 patients had excellent healing of their skull base and had no evidence of any postoperative cerebrospinal fluid leaks. Eight patients had radiation therapy without flap complications. Radiographic studies demonstrate that the adequate PCF length, covering defects of the anterior skull base, sellar, and clival defects are 11.31 to 12.44 cm, 14.31 to 15.57 cm, and 18.5 to 20.42 cm, respectively.
  
  
  CONCLUSIONS
  The PCF provides an option for endonasal reconstruction of cranial base defects and can be harvested endoscopically. Pre-operative radiographic evaluation may guide surgical planning. There is minimal donor site morbidity, and the flap provides enough surface area to cover the entire ventral skull base.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, University of North Carolina School of Medicine Chapel Hill, North Carolina 27599, USA.
authors.forename: Mihir R
authors.initials: MR
authors.lastname: Patel
authors.forename: Rupali N
authors.initials: RN
authors.lastname: Shah
authors.forename: Carl H
authors.initials: CH
authors.lastname: Snyderman
authors.forename: Ricardo L
authors.initials: RL
authors.lastname: Carrau
authors.forename: Anand V
authors.initials: AV
authors.lastname: Germanwala
authors.forename: Amin B
authors.initials: AB
authors.lastname: Kassam
authors.forename: Adam M
authors.initials: AM
authors.lastname: Zanation
mesh_terms: D001932:Brain Neoplasms / Q000601:surgery; D015331:Cohort Studies; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D019291:Skull Base / Q000000981:diagnostic imaging* / Q000601:surgery*; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome