Vascularized rotational temporal bone flap for repair of anterior skull base defects: a novel operative technique

Abstract

Repair of anterior skull base defects with vascularized grafts poses a significant challenge, given the location and small number of adequately sized vessels for free-flap anastomosis. This is particularly the case in the setting of redo surgery or in patients with preexisting soft-tissue trauma. Even more difficult is achieving a vascularized bone flap closure of such bony defects. The authors report a novel technique involving a rotational temporal bone flap with a temporalis muscle vascularized pedicle, which was used to repair an anterior fossa bony and soft-tissue defect created by recurrent malignancy. A 55-year-old man with history of scalp avulsion during a motor vehicle accident, anterior fossa/nasopharyngeal malignant neuroendocrine carcinoma postresection, and bone flap infection presented with a recurrence of his skull base malignancy. The tumor was located in the anterior fossa, extending interhemispherically and down through the cribriform plate, ethmoid air cells, and extending into the nasopharyngeal cavity. Resection of the recurrent tumor was performed. The bony defect in the anterior skull base was repaired with a novel vascularized rotational temporal bone flap, with acceptable separation of the nasopharynx from the intracranial cavity. The vascularized rotational temporal bone flap, in which a temporalis muscle pedicle is used, provides a novel and easily accessible means of vascularized bone closure of anterior skull base defects without the need for microsurgical free-flap grafting.