Pediatric skull base reconstruction: case report of a tunneled temporoparietal fascia flap

• Published in: Journal of neurosurgery. Pediatrics Vol. 17; no. 3; pp. 371 - 377
• Main Authors: Rastatter, Jeffrey C, Walz, Patrick C, Alden, Tord D
• Format: Journal Article
• Language: English
• Published: United States 01-03-2016
• Subjects: Cerebrospinal Fluid Leak - surgery; Child; Chordoma - surgery; Endoscopy - methods; Female; Humans; Magnetic Resonance Imaging; Neoplasm Recurrence, Local - surgery; Reconstructive Surgical Procedures - methods; Skull Base - surgery; Skull Base Neoplasms - surgery; Surgical Flaps; Treatment Outcome; CNS = central nervous system; cranial base; CSF = cerebrospinal fluid; technique; ITF = infratemporal fossa; skull base; EVD = external ventricular drain; TPF = temporoparietal fascia; pediatric; endoscopic; EEA = endoscopic endonasal approach; STA = superficial temporal artery; tunneled temporoparietal fascia flap; reconstruction; chordoma
• ISSN: 1933-0707; 1933-0715
• DOI: 10.3171/2015.6.peds1588

The authors of this report present a pediatric case involving the use of a tunneled temporoparietal fascia flap to reconstruct a skull base defect for a multiply recurrent clival chordoma and cerebrospinal fluid leak, demonstrate the surgical technique through illustrations and intraoperative photos, and review the pertinent literature. A 9-year-old female patient underwent extensive clival chordoma resection via both the endoscopic and open approaches, which ultimately exhausted the bilateral nasoseptal flaps and other intranasal reconstructive options. Following proton beam radiation and initiation of chemotherapy, tumor recurrence was managed with further endoscopic resection, which was complicated by a recalcitrant cerebrospinal fluid leak. A tunneled temporoparietal fascia flap was used to provide vascular tissue to augment an endoscopic repair of the leak and reconstruction of the skull base. While the nasoseptal flap remains the workhorse for many pediatric and adult endoscopic skull base reconstructions, the tunneled temporoparietal fascia flap has a demonstrated efficacy in adults when the nasoseptal flap and other intranasal flaps are unavailable. This report documents a pediatric case, serving as a step toward establishing this technique in the pediatric population.