Supplementary Material for: Nasoseptal Flap

<p>The nasoseptal flap had an important role in the development of endoscopic endonasal surgery of the cranial base. The flap is pedicled upon the posterior septal artery, which is a terminal branch of the sphenopalatine artery. The reliable vascular supply promotes rapid healing and the flap is an effective barrier for the prevention of CSF leaks. For large skull base defects, it has dramatically decreased the risk of a postoperative CSF leak to less than 5%. The nasoseptal flap is a versatile flap with a wide arc of rotation that allows the flap to reach defects from the frontal sinus to the lower clivus. This chapter provides a comprehensive review of the nasoseptal flap. The harvesting and reconstruction techniques, modifications of the flap and complications are described.</p

The learning curve for endonasal surgery of the cranial base: a systematic approach to training

Proper training in endoscopic endonasal surgery of the cranial base is essential to avoid unnecessary morbidity and mortality. An incremental program for the training of skull base surgeons is described that accounts for complex skull base anatomy, technical difficulty, potential risk of neural and vascular injury, extent of intradural dissection, and type of pathology. There are multiple pathways for training in endoscopic skull base surgery. The most important feature of a training program is the building of team surgical skills.Carl H. Snyderman, Harshita Pant, Amin B. Kassam, Ricardo L. Carrau, Daniel M. Prevedello, Paul A. Gardne

Management of Complications of Endonasal Cranial Base Surgery

Endoscopic endonasal surgery of the cranial base is maximally invasive surgery and poses many of the same risks as traditional skull base approaches. Preliminary data demonstrates that serious complications can be avoided through a strong foundation in endoscopic skull base anatomy, adherence to principles of surgical dissection, and a dedicated surgical team with proper training and experience. Surgical complications may be categorized by severity, location, organ system or tissue type, and time period. Advances in reconstruction have decreased the incidence of CSF leaks to less than 5%. Major complications such as vascular injury are rare and can be managed using endoscopic techniques. Nasal morbidity is acceptable.Snyderman C.H., Pant H., Gardner P.A., Carrau R.L., Prevedello D.M., Kassam A.B

Endoscopic nasopharyngectomy and its role in managing locally recurrent nasopharyngeal carcinoma

10.1016/j.otc.2011.07.002Otolaryngologic Clinics of North America4451141-1154OCNA

The role of skull base surgery for the treatment of adenoid cystic carcinoma of the sinonasal tract

PubMedID: 10402519Background. Adenoid cystic carcinoma (ACC) of the sinonasal tract is an aggressive malignancy associated with a poor 5-year survival rate. The role of skull base surgery for the treatment of patients presenting with sinonasal ACC and its impact upon their survival has not previously been evaluated. Methods. A retrospective review of 35 patients with ACC of the sinonasal tract who were treated with surgery and radiation therapy at the University of Pittsburgh Medical Center was performed to evaluate patient outcome. Results. Local recurrence of tumor following surgery and radiation therapy was observed in 36% of the patients originally treated at the University of Pittsburgh Medical Center. Fourteen percent of these patients developed a regional tumor recurrence, and 21% developed distant metastases. We did not identify any tumor-related factors that predicted patient outcome. Local recurrences were treated with salvage surgical excision, and, despite aggressive management, only 1 of 17 patients with local recurrence was considered cured (NED) at 24 months (follow-up after salvage surgery). Overall, disease-free survival was 46.4%, at a median follow-up of 40 months. Conclusions. ACC of the sinonasal tract is an aggressive malignancy. Skull base surgery has facilitated the gross total excision of advanced lesions that were deemed inoperable in the past, but has not resulted in an overall improvement in disease-free survival. Local recurrence portends a very poor prognosis, despite aggressive salvage regimens. Alternative therapies for local recurrences warrant further investigation. Prospective, randomized studies are necessary to evaluate the outcome of patients treated with aggressive multimodal treatment regimens, including chemotherapeutic regimens

Minimally invasive techniques for head and neck malignancies: current indications, outcomes and future directions

Item does not contain fulltextThe trend toward minimally invasive surgery, appropriately applied, has evolved over the past three decades to encompass all fields of surgery, including curative intent cancer surgery of the head and neck. Proper patient and tumor selection are fundamental to optimizing oncological and functional outcomes in such a personalized approach to cancer treatment. Training, experience, and appropriate technological equipment are prerequisites for any type of minimally invasive surgery. The aim of this review was to provide an overview of currently available techniques and the evidence justifying their use. Much evidence is in favor of routine use of transoral laser resection, transoral robot-assisted surgery, transnasal endoscopic resection, sentinel node biopsy, and endoscopic neck surgery for selected malignant tumors, by experienced surgical teams. Technological advances will enhance the scope of this type of surgery in the future and physicians need to be aware of the current applications and trends

Sacrifice and extracranial reconstruction of the common or internal carotid artery in advanced head and neck carcinoma: Review and meta-analysis

Contains fulltext : 193460.pdf (publisher's version ) (Closed access)BACKGROUND: Sacrifice and reconstruction of the carotid artery in cases of head and neck carcinoma with invasion of the common or internal carotid artery is debated. METHODS: We conducted a systematic search of electronic databases and provide a review and meta-analysis. RESULTS: Of the 72 articles identified, 24 met the inclusion criteria resulting in the inclusion of 357 patients. The overall perioperative 30-day mortality was 3.6% (13/357). Permanent cerebrovascular complications occurred in 3.6% (13/357). Carotid blowout episodes were encountered in 1.4% (5/357). The meta-regression analysis showed a significant difference in 1-year overall survival between reports published from 1981-1999 (37.0%) and 2001-2016 (65.4%; P = .02). CONCLUSION: This review provides evidence that sacrifice with extracranial reconstruction of common or internal carotid artery in selected patients with head and neck carcinoma may improve survival with acceptable complication rates. However, all of the published literature is retrospective involving selected series and, therefore, precludes determining the absolute effectiveness of the surgery