Radio-anatomical analysis of the pericranial flap "money box approach" for ventral skull base reconstruction.
To evaluate the versatility of the pericranial flap (PCF) to reconstruct the ventral skull base, using the frontal sinus as a gate for its passage into the sinonasal corridor "money box approach."



Anatomic-radiological study and case series.



Various approaches and their respective defects (cribriform, transtuberculum, clival, and craniovertebral junction) were completed in 10 injected specimens. The PCF was introduced into the nose through the uppermost portion of the frontal sinus (money box approach). Computed tomography (CT) scans (n = 50) were used to measure the dimensions of the PCF and the skull base defects. The vertical projection of the external ear canal was used as the reference point to standardize the incisions for the PCF.



The surface area and maximum length of the PCF were 121.5 ± 19.4 cm2and 18.3 ± 1.3 cm, respectively. Using CT scans, we determined that to reconstruct defects secondary to transcribriform, transtuberculum, clival, and craniovertebral approaches, the PCF distal incision must be placed respectively at -3.7 ± 2.0 cm (angle -17.4 ± 8.5°), -0.2 ± 2.0 cm (angle -1.0 ± 9.3°), +5.5 ± 2.3 cm (angle +24.4 ± 9.7°), +8.4 ± 2.4 cm (angle +36.6 ± 11.5°), as related to the reference point. Skull base defects in our clinical cohort (n = 6) were completely reconstructed uneventfully with the PCF.



The PCF renders enough surface area to reconstruct all possible defects in the ventral and median skull base. Using the uppermost frontal sinus as a gateway into the nose (money box approach) is feasible and simple.



NA. Laryngoscope, 127:2482-2489, 2017.
Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Alfonso
A
Santamaría
Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Cristóbal
C
Langdon
Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Mauricio
M
López-Chacon
Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Arturo
A
Cordero
Department of Neurosurgery, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Joaquim
J
Enseñat
Department of Otolaryngology-Head and Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.
Ricardo
R
Carrau
Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, University of Barcelona, Barcelona, Spain.|August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain.|Biomedical Research Networking Center on Respiratory Diseases, Madrid, Spain.
Manuel
M
Bernal-Sprekelsen
Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, University of Barcelona, Barcelona, Spain.|August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain.|Biomedical Research Networking Center on Respiratory Diseases, Madrid, Spain.
Isam
0000-0001-7204-5599
I
Alobid
D002102:Cadaver; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009296:Nasal Cavity / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D019291:Skull Base / Q000000981:diagnostic imaging* / Q000601:surgery*; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed
Cerebrospinal fluid leak; dural defect; endoscopic endonasal skull base surgery; pedicled flap; pericranial flap; skull base reconstruction