Reconstruction of Transcribriform Skull Base Defects

A 51 year-old male presented to an outside otolaryngologist with recurrent facial pain and congestion. He was found to have a left-sided nasal mass.  A work-up was performed, complete with biopsy, which was diagnosed as non-intestinal type adenocarcinoma.  He underwent resection via the endoscopic endonasal transcribriform approach.  In this video publication, we present our preferred method of reconstruction for sinonasal malignancies treated by endoscopic transcribriform resection using a multilayered closure with the following: a subdural DuraGen inlay graft, a fascia lata onlay graft, and an extradural, extracranial onlay pericranial flap via nasionectomy.  A lumbar drain was placed at the end of the case for CSF diversion until the fifth postoperative day.

Contributors:

Paul A. Gardner, MD, Eric W. Wang, MD, Juan C. Fernandez-Miranda, MD, and Carl H. Snyderman, MD, MBA

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