A case of Dr. Alfonso Santamaría
This time in SurgSchool, surgical training app, the Dr. Alfonso Santamaría presents a fascinating case of skull base reconstruction using a pericranial flap. This intervention was performed on a 62-year-old patient with a diagnosis of bilateral meningocele that completely covered the cribriform plate.
Surgical Technique: Pericranial Flap
The surgery began with the preparation of the nasal fossa by removing the middle turbinates and performing a DRAF 3, which allowed adequate access to the defect. The first attempt at reconstruction with a nasoseptal flap was not sufficient due to the extent of the defect. Given this situation, Dr. Santamaría opted for a pericranial flap, an approach that offers broader and safer coverage.
The pericranial flap was obtained through a coronal incision, allowing a bilateral flap to be raised that was introduced into the nasal fossa using an endoscopic approach. This technique, known as the "Moneybox Approach", has proven to be highly effective in the reconstruction of large skull base defects.
Advantages of the Pericranial Flap
The pericranial flap is less known among otorhinolaryngologists, but offers numerous advantages in skull base reconstruction. Unlike the nasoseptal flap, the pericranial flap provides more extensive coverage and is ideal for large, bilateral defects. Furthermore, when combined with the nasoseptal flap, the reconstruction is reinforced, minimizing the risk of fistulas and recurrences.
Postoperative and Results
Postoperative follow-up showed complete epithelialization of the pericranial flap and patency of the right frontal sinus without recurrence. This confirms the effectiveness of the technique and its feasibility in similar cases.
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