title: Training cerebrospinal fluid leak repair with nasoseptal flap on the lamb's head.
abstract: BACKGROUND
  One of the major challenges of cranial base surgery is reconstruction of dural defects and cerebrospinal fluid leak closure. Various grafting methods have been used for smaller skull base defects with great success. The indications for endoscopic reconstruction have recently evolved to encompass much larger breeches in the skull base following tumor removal, thus emphasizing the need for vascularized tissue flaps for reconstruction.
  
  
  METHODS
  Some authors proposed a pedicled flap of the nasal septum mucoperiosteum and mucoperichondrium, which is very vascularized and has quite a large surface. It is also long enough to easily cover even larger defects of the skull base. The elevation of a nasoseptal flap is based on a particularly advanced surgical technique and thus requires proper training before being performed in a real patient.
  
  
  RESULTS
  Anatomical differences between human and lamb heads were observed and explained although they do not affect the procedure of the elevation of the nasoseptal flap.
  
  
  CONCLUSIONS
  The lamb's head has been shown to be an ideal model for the adequate training of the surgical skills required for this demanding procedure.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University Hospital Rebro, Zagreb, Croatia.
authors.forename: Ranko
authors.initials: R
authors.lastname: Mladina
authors.forename: Paolo
authors.initials: P
authors.lastname: Castelnuovo
authors.forename: Davide
authors.initials: D
authors.lastname: Locatelli
authors.forename: Katarina
authors.initials: K
authors.lastname: Đurić Vuković
authors.forename: Neven
authors.initials: N
authors.lastname: Skitarelić
mesh_terms: D000818:Animals; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000601:surgery*; D023421:Models, Animal; D009296:Nasal Cavity / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D012756:Sheep; D019291:Skull Base / Q000601:surgery*; D013524:Surgical Flaps