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CC BY-NC-ND 4.0 · J Neurol Surg Rep 2023; 84(03): e87-e91
DOI: 10.1055/s-0043-1772200
Original Report

Bilateral Inferior Turbinate Flaps for Salvage Reconstruction after Proton Beam Radiotherapy for Clival Chordoma

Kayva L. Crawford 
1   Department of Otolaryngology – Head & Neck Surgery, University of California San Diego, La Jolla, California, United States
,
Megana Saripella
2   School of Medicine, University of California San Diego, La Jolla, California, United States
,
Adam S. DeConde
1   Department of Otolaryngology – Head & Neck Surgery, University of California San Diego, La Jolla, California, United States
,
Thomas L. Beaumont
3   Department of Neurological Surgery, University of California San Diego, La Jolla, California, United States
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Abstract

Clival chordoma is a rare, aggressive, notochord-derived tumor primarily managed with surgery via an endoscopic endonasal approach (EEA) and adjuvant proton beam radiotherapy. Reconstruction is commonly performed with a nasoseptal flap (NSF) at the time of initial surgery. While failures of the NSF are rare, they can occur following the initial surgery or in the setting of osteoradionecrosis. Salvage repair typically requires transfer of alternative vascularized tissues outside of the previously radiated field including regional scalp flaps such as pericranial or temporoparietal fascial flaps, or free vascularized tissue transfer. Here we describe the case of a 29-year-old woman with a history of clival chordoma with widespread skull base osteomyelitis secondary to NSF necrosis after proton beam radiotherapy. We describe successful skull base reconstruction with intranasal bilateral inferior turbinate flaps based on the sphenopalatine artery with lateral nasal wall extension, despite prior proton beam therapy and a failed prior vascularized intranasal reconstruction.

Keywords

chordoma - inferior turbinate - flap - osteoradionecrosis - proton - radiotherapy


Publikationsverlauf

Eingereicht: 08. Februar 2023

Angenommen: 17. Juni 2023

Artikel online veröffentlicht:
11. August 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 McMaster ML, Goldstein AM, Bromley CM, Ishibe N, Parry DM. Chordoma: incidence and survival patterns in the United States, 1973-1995. Cancer Causes Control 2001; 12 (01) 1-11
    CrossrefPubMedGoogle Scholar
  • 2 Walcott BP, Nahed BV, Mohyeldin A, Coumans JV, Kahle KT, Ferreira MJ. Chordoma: current concepts, management, and future directions. Lancet Oncol 2012; 13 (02) e69-e76
    CrossrefPubMedGoogle Scholar
  • 3 Culebras D, Torales J, Reyes LA. et al. Extended endoscopic endonasal surgery for clival chordoma and chondrosarcoma: our experience in 14 cases. Neurocirugia (Astur : Engl Ed) 2018; 29 (04) 201-208
    CrossrefPubMedGoogle Scholar
  • 4 Hadad G, Bassagasteguy L, Carrau RL. et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006; 116 (10) 1882-1886
    CrossrefPubMedGoogle Scholar
  • 5 Thorp BD, Sreenath SB, Ebert CS, Zanation AM. Endoscopic skull base reconstruction: a review and clinical case series of 152 vascularized flaps used for surgical skull base defects in the setting of intraoperative cerebrospinal fluid leak. Neurosurg Focus 2014; 37 (04) E4
    CrossrefPubMedGoogle Scholar
  • 6 Yip J, Macdonald KI, Lee J. et al. The inferior turbinate flap in skull base reconstruction. J Otolaryngol Head Neck Surg 2013; 42 (01) 6
    CrossrefPubMedGoogle Scholar
  • 7 Fortes FS, Carrau RL, Snyderman CH. et al. The posterior pedicle inferior turbinate flap: a new vascularized flap for skull base reconstruction. Laryngoscope 2007; 117 (08) 1329-1332
    CrossrefPubMedGoogle Scholar
  • 8 Hanasono MM, Sacks JM, Goel N, Ayad M, Skoracki RJ. The anterolateral thigh free flap for skull base reconstruction. Otolaryngol Head Neck Surg 2009; 140 (06) 855-860
    CrossrefPubMedGoogle Scholar
  • 9 Arosio AD, Coden E, Karligkiotis A. et al. Temporoparietal fascia flap endonasal transposition in skull base reconstruction: surgical technique. World Neurosurg 2021; 146: 118
    CrossrefPubMedGoogle Scholar
  • 10 Yamada H, Toda M, Fukumura M. et al. Cerebrospinal fluid leakage due to nasoseptal flap partial necrosis: a pitfall for skull base reconstruction of endoscopic endonasal surgery. Surg Neurol Int 2020; 11 (121) 121
    CrossrefPubMedGoogle Scholar
  • 11 Chabot JD, Patel CR, Hughes MA. et al. Nasoseptal flap necrosis: a rare complication of endoscopic endonasal surgery. J Neurosurg 2018; 128 (05) 1463-1472
    CrossrefPubMedGoogle Scholar
  • 12 Harvey RJ, Parmar P, Sacks R, Zanation AM. Endoscopic skull base reconstruction of large dural defects: a systematic review of published evidence. Laryngoscope 2012; 122 (02) 452-459
    CrossrefPubMedGoogle Scholar
  • 13 Lavigne P, Faden DL, Wang EW, Snyderman CH. Complications of nasoseptal flap reconstruction: a systematic review. J Neurol Surg B Skull Base 2018; 79 (10, Suppl 4): S291-S299
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 14 Zanation AM, Carrau RL, Snyderman CH. et al. Nasoseptal flap reconstruction of high flow intraoperative cerebral spinal fluid leaks during endoscopic skull base surgery. Am J Rhinol Allergy 2009; 23 (05) 518-521
    CrossrefPubMedGoogle Scholar
  • 15 Ruffner R, Pereira MC, Patel V, Peris-Celda M, Pinheiro-Neto CD. Inferior meatus mucosal flap for septal reconstruction and resurfacing after nasoseptal flap harvest. Laryngoscope 2021; 131 (05) 952-955
    CrossrefPubMedGoogle Scholar
  • 16 Lee DH, Yoon TM, Lee JK. et al. Clinical utility of the inferior turbinate flaps in the reconstruction of the nasal septum and skull base. J Craniofac Surg 2012; 23 (04) e322-e326
    CrossrefPubMedGoogle Scholar
  • 17 Gil Z, Margalit N. Anteriorly based inferior turbinate flap for endoscopic skull base reconstruction. Otolaryngol Head Neck Surg 2012; 146 (05) 842-847
    CrossrefPubMedGoogle Scholar
  • 18 Kim SM, Park HW, Park MS. et al. Fulminant meningitis after radiotherapy for clival chordoma. Brain Tumor Res Treat 2013; 1 (02) 107-110
    CrossrefPubMedGoogle Scholar
  • 19 Moon JH, Kim EH, Kim SH. Various modifications of a vascularized nasoseptal flap for repair of extensive skull base dural defects. J Neurosurg 2019; 132 (02) 371-379
    CrossrefPubMedGoogle Scholar