title: How I do it. The pedicled temporoparietal fascia flap for skull base reconstruction after endonasal endoscopic approaches.
abstract: Endoscopic endonasal approaches (EEA) are an alternative for removing challenging nasopharyngeal or skull base lesions. In some cases, a nasoseptal flap (NSF) is not always available and such complex procedures may lead to carotid arteries exposition and/or dura mater (DM) wide opening. Meticulous carotid coverage and DM reconstruction are crucial for preventing early and delayed complications.
  
  
  
  We propose a step-by-step description of the pedicled temporoparietal fascia flap (TPFF) technique, with a focus on its pitfalls, advantages and limits.
  
  
  
  The TPFF is a reliable flap for skull base reconstruction when other pedicled flaps are not available.
  
  
  
  1. Reliable flap even for irradiated patients 2. CT angiography with 3D reconstruction as pre-operative imaging 3. Doppler ultrasound probe to draw the artery's trajectory on skin 4. TPFF elevation concomitantly to the endoscopic procedure 5. Hemicoronal incision sufficient to harvest the TPFF 6. Superficial dissection in a plane just beneath the hair follicles 7. Dissection plane deep to the fad pad to preserve the frontal branch of the facial nerve 8. Surgical corridor wide enough to avoid any compression of the pedicle 9. Double visualization to avoid any twist and Doppler control of the STA patency 10. Close follow-up, toilet in clinics.
authors.affiliation: Department of Head and Neck Surgery, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris-Diderot, Sorbonne Paris-Cité, Hôpital Lariboisière; 2, rue Ambroise Paré, 75010, Paris, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Veyrat
authors.affiliation: Department of Head and Neck Surgery, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris-Diderot, Sorbonne Paris-Cité, Hôpital Lariboisière; 2, rue Ambroise Paré, 75010, Paris, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Verillaud
authors.affiliation: Department of Head and Neck Surgery, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris-Diderot, Sorbonne Paris-Cité, Hôpital Lariboisière; 2, rue Ambroise Paré, 75010, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Herman
authors.affiliation: Department of Neurosurgery, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France. damien.bresson@aphp.fr.
authors.forename: Damien
authors.identifier: 0000-0001-6250-8932
authors.initials: D
authors.lastname: Bresson
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000379:methods*; D009666:Nose / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D019291:Skull Base / Q000601:surgery*; D013524:Surgical Flaps / Q000009:adverse effects* / Q000601:surgery
keywords: Dural defects; Endoscopic surgery; Nasopharyngectomy; Radiotherapy; Reconstruction; Skull base; Temporoparietal fascia flap