title: Split-calvarial osteopericranial flap for reconstruction following endoscopic anterior resection of cranial base.
abstract: OBJECTIVE
  To conceive and critically evaluate an adaptation of the split calvarial osteopericranial flap for reconstruction following endoscopic endonasal resection of the anterior skull base.
  
  
  METHODS
  Cadaveric anatomic study.
  
  
  METHODS
  Five cadavers were embalmed with methanol, and vasculature was injected with latex. Endoscopic endonasal resection of the anterior skull base was performed, followed by reconstruction with a unilateral osteopericranial flap and a contralateral conventional pericranial flap.
  
  
  RESULTS
  Rigid reconstruction was achieved in all specimens. Osteoplastic flap harvest was made more reliable by drilling the diploe below the graft with a curved bur. Dimensions of the bony flap were ideally shorter and wider than the defect, allowing for flap inset and rigid support by the orbits without compromise of the flap vascular supply. Endoscopic inset of the flap is feasible via nasion-frontal osteotomy and inlay technique.
  
  
  CONCLUSIONS
  Rigid anterior skull base reconstruction via split calvarial osteopericranial flap is adaptable to current endoscopic techniques. This provides more anatomic reconstruction than current methods and may lead to decreased complication rates following anterior skull base resection.
authors.affiliation: Division of Otolaryngology and Head-Neck Surgery, Department of Surgery, Albany Medical College, Albany, New York, U.S.A.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Engle
authors.forename: Anna
authors.initials: A
authors.lastname: Butrymowicz
authors.forename: Maria
authors.initials: M
authors.lastname: Peris-Celda
authors.forename: Tyler J
authors.initials: TJ
authors.lastname: Kenning
authors.forename: Carlos D
authors.initials: CD
authors.lastname: Pinheiro-Neto
mesh_terms: D016025:Bone Transplantation / Q000379:methods; D002102:Cadaver; D004210:Dissection / Q000379:methods; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009296:Nasal Cavity / Q000601:surgery; D010027:Osteotomy / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D012680:Sensitivity and Specificity; D019291:Skull Base / Q000601:surgery*; D013524:Surgical Flaps / Q000637:transplantation*
keywords: CSF leak; Pericranial flap; anterior cranial base; cranial base reconstruction; craniofacial resection; pedicled flap