title: The turbinal flap: an additional option for anterior skull base reconstruction. Cadaveric feasibility study and case report.
abstract: Over the past decade, the treatment of complex intradural and extradural pathologies via expanded endonasal approaches has been made possible by progresses and refinements in skull base reconstruction techniques. The aim of this anatomic study is to describe a novel endonasal flap, the turbinal flap (TF), based on the middle and superior turbinate mucosa and pedicled on the ethmoidal arteries system.
  
  
  
  Three fresh-frozen (6 sides) cadaver heads previously injected with colored silicone were dissected. A step-by-step description of the surgical technique is provided. Vascularization of the TF and its range of possibilities to cover anterior skull base defects were studied. Flap dimensions and area were measured. A case report where the TF was successfully used is also described.
  
  
  
  The TF was adequate to repair defects along the entire ethmoid roof. Its pedicle along the skull base was 3.0 cm in length and sagittally oriented. Mean measures of the TF were 3.4 cm (anterior height), 5.5 cm (posterior height), and 4.8 cm (inferior length). Its mean area was 8.6 cm2. The flap was supplied by rich network of vessels. A demonstrative case of anterior skull base repair after the endoscopic resection of meningocephalocele of the ethmoid roof is reported.
  
  
  
  The main indication for the TF is the repair of anterior skull base defects involving the ethmoid roof. Its advantages include the double pedicle, rich vascularization, autonomy from the maxillary artery system, and preservation of the olfactory mucosa.
authors.affiliation: Units of Otorhinolaryngology-Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Schreiber
authors.affiliation: Units of Otorhinolaryngology-Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Mattavelli
authors.affiliation: Units of Otorhinolaryngology-Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Ferrari
authors.affiliation: Units of Otorhinolaryngology-Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Rampinelli
authors.affiliation: Units of Otorhinolaryngology-Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Lancini
authors.affiliation: Units of Neurosurgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Belotti
authors.affiliation: Units of Otorhinolaryngology-Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
authors.forename: Luigi Fabrizio
authors.initials: LF
authors.lastname: Rodella
authors.affiliation: Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Nicolai
mesh_terms: D002102:Cadaver; D065634:Cerebrospinal Fluid Leak / Q000000981:diagnostic imaging / Q000601:surgery; D004677:Encephalocele / Q000000981:diagnostic imaging / Q000601:surgery; D004724:Endoscopy; D005004:Ethmoid Bone / Q000000981:diagnostic imaging / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008588:Meningocele / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods; D019291:Skull Base / Q000601:surgery*; D013524:Surgical Flaps; D014420:Turbinates / Q000601:surgery*
keywords: CSF rhinorrhea; anterior skull base; endoscopic skull base surgery; skull base repair; turbinal flap