Letter to the Editor: Vascularized rotational temporal bone flap

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TO THE EDITOR: I read the article by Zeiler and Kaufmann15 with interest (Zeiler FA, Kaufmann AM: Vascularized rotational temporal bone flap for repair of anterior skull base defects: a novel operative technique. J Neurosurg 123:1312–1315, November 2015). The authors mention that they discuss a novel technique of skull base reconstruction using a vascularized flap that is based on temporalis muscle. It is surprising that the authors did not have access to standard reference databases and have ignored my several articles on the technique discussed and on the subject.1–14 I believe such articles that do not respect published work have a negative impact on scientific literature and future publications that will be based on the study.

I first reported vascularized pericranial bone flap for reconstruction of the anterior cranial fossa floor.9 In the year 1994 I reported temporalis osteomyoplastic bone flap for reconstruction of the middle fossa floor.10 Although posterior temporal bone flaps can be based entirely on temporalis muscle for reconstruction of anterior cranial base, stretching of the vascular pedicle due to the relatively long distance can be a deterrent. Considering this issue, we based bone flaps on pericranium. To increase the thickness of the vascular pedicle, we discussed long vascularized pedicle flaps based on temporalis muscle and its superficial and deep fascial layers.2,3 Inclusion of “subgaleal fascia” in the vascular pedicle adds to the vascularity of the flap.11 I also discussed deployment of multilayered temporalis muscle-based vascularized flaps for both the middle fossa and anterior cranial fossa floor.4–5 The long length, ease of harvesting and deployment, and versatility of the temporalis muscle-based flaps have not been adequately exploited. The utility of vascularized flaps in situations where the host region is of less than optimum vascularity cannot be overemphasized.12,13

References

  • 1

    Goel AAlternative methods for reconstruction of skull base bone using locally available alternatives. Torrens MJAl-Mefty AKobayashi S: Operative Skull Base Surgery New YorkChurchill Livingstone1997. 359372

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  • 2

    Goel A: Extended vascularised temporalis muscle-fascia flap. Br J Neurosurg 8:7317331994

  • 3

    Goel A: Long vascular pedicle cranial flap. Br J Neurosurg 9:6676701995

  • 4

    Goel A: Multilayer reconstruction of the anterior cranial fossa floor. Br J Neurosurg 12:2542581998

  • 5

    Goel A: Multilayer reconstruction of the middle fossa floor. Acta Neurochir (Wien) 138:5845891996

  • 6

    Goel A: Reconstructing the “skull base” divide. World Neurosurg 81:54552014

  • 7

    Goel A: Reconstruction of the skull base using locally available alternative: a review. Indian J Plast surg 25:57621995

  • 8

    Goel A: Use of outer layer of dura as a pedicled flap. Surg Neurol 44:92931995

  • 9

    Goel A: Vascularised bone flap for anterior skull base reconstruction. Acta Neurochir (Wien) 128:1661681994

  • 10

    Goel A: Vascularized osteomyoplastic flaps for skull base reconstruction. Br J Neurosurg 8:79821994

  • 11

    Goel AGahankari D: Extended subgaleal fascia—pericranial flap for anterior skull base reconstruction. Acta Neurochir (Wien) 135:2032051995

    • Search Google Scholar
    • Export Citation
  • 12

    Goel AGupta S: Reconstruction of the skull base: a review of personal techniques. Neurol India 48:2082152000

  • 13

    Goel AMuzumdar DP: Reconstruction of the sella floor using vascularized pedicled mucosal flap. Br J Neurosurg 17:5535552003

  • 14

    Goel ANitta JKobayashi SHongo KReconstruction of the skull base. Kobayashi SGoel AHongo K: Neurosurgery of complex Tumours and Vascular lesions New YorkChurchill Livingstone1997. 393414

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    • Export Citation
  • 15

    Zeiler FAKaufmann AM: Vascularized rotational temporal bone flap for repair of anterior skull base defects: a novel operative technique. J Neurosurg 123:131213152015

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Keywords:

Response

We write in response to the letter to the editor from Professor Goel regarding our recent manuscript in the Journal of Neurosurgery on the application of a rotational vascularized temporal bone flap for anterior fossa repair. Professor Goel, thank you for your comments.

We acknowledge that indeed there are contributions to the literature from Professor Goel regarding skull base repair.1–14 The articles mentioned in his letter describe a variety of different techniques, and he includes references to some review articles on the subject.1,6,7,12,14 Vascularized rotational bone flaps for middle fossa defects,5,10 vascularized soft-tissue flaps for a variety of skull base locations,2,4,8,11,13 vascularized rotational bone grafts for calvarial defects,3 and even anterior fossa repair via split-thickness frontal bone grafts with pericranial pedicles9 have been described by Professor Goel, and these works are all quoted in his letter to the editor. We do believe that these contributions are important and valuable resources for practitioners dealing with such issues surrounding skull base reconstruction. The impact of these contributions should not be minimized.

However, our particular technique, in terms of the location of the graft (posterior temporal bone), the length and method of pedicle rotation, and the location of reconstruction (anterior fossa), has not been described in the literature in this particular combination to our knowledge. We do acknowledge that descriptions from Professor Goel do include anterior fossa repair via soft-tissue flaps4 and split-thickness frontal bone grafts with a pericranial pedicle.9 These accounts are, however, different from ours. Thus, we believe that our case demonstrates a novel variation that, when added to the armamentarium of techniques previously described by Professor Goel and others, will provide the practicing neurosurgeon with a skill set for the repair of a variety of skull base locations.

References

  • 1

    Goel AAlternative methods for reconstruction of skull base bone using locally available alternatives. Torrens MJAl-Mefty AKobayashi S: Operative Skull Base Surgery New YorkChurchill Livingstone1997. 359372

    • Search Google Scholar
    • Export Citation
  • 2

    Goel A: Extended vascularised temporalis muscle-fascia flap. Br J Neurosurg 8:7317331994

  • 3

    Goel A: Long vascular pedicle cranial flap. Br J Neurosurg 9:6676701995

  • 4

    Goel A: Multilayer reconstruction of the anterior cranial fossa floor. Br J Neurosurg 12:2542581998

  • 5

    Goel A: Multilayer reconstruction of the middle fossa floor. Acta Neurochir (Wien) 138:5845891996

  • 6

    Goel A: Reconstructing the “skull base” divide. World Neurosurg 81:54552014

  • 7

    Goel A: Reconstruction of the skull base using locally available alternative: a review. Indian J Plast Surg 25:57621995

  • 8

    Goel A: Use of outer layer of dura as a pedicled flap. Surg Neurol 44:92931995

  • 9

    Goel A: Vascularised bone flap for anterior skull base reconstruction. Acta Neurochir (Wien) 128:1661681994

  • 10

    Goel A: Vascularized osteomyoplastic flaps for skull base reconstruction. Br J Neurosurg 8:79821994

  • 11

    Goel AGahankari D: Extended subgaleal fascia—pericranial flap for anterior skull base reconstruction. Acta Neurochir (Wien) 135:2032051995

    • Search Google Scholar
    • Export Citation
  • 12

    Goel AGupta S: Reconstruction of the skull base: a review of personal techniques. Neurol India 48:2082152000

  • 13

    Goel AMuzumdar DP: Reconstruction of the sella floor using vascularized pedicled mucosal flap. Br J Neurosurg 17:5535552003

  • 14

    Goel ANitta JKobayashi SHongo KReconstruction of the skull base. Kobayashi SGoel AHongo K: Neurosurgery of Complex Tumours and Vascular Lesions New YorkChurchill Livingstone1997. 393414

    • Search Google Scholar
    • Export Citation

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Article Information

Contributor Notes

INCLUDE WHEN CITING Published online November 6, 2015; DOI: 10.3171/2015.5.JNS151146.DISCLOSURE The author reports no conflict of interest.
Headings
References
  • 1

    Goel AAlternative methods for reconstruction of skull base bone using locally available alternatives. Torrens MJAl-Mefty AKobayashi S: Operative Skull Base Surgery New YorkChurchill Livingstone1997. 359372

    • Search Google Scholar
    • Export Citation
  • 2

    Goel A: Extended vascularised temporalis muscle-fascia flap. Br J Neurosurg 8:7317331994

  • 3

    Goel A: Long vascular pedicle cranial flap. Br J Neurosurg 9:6676701995

  • 4

    Goel A: Multilayer reconstruction of the anterior cranial fossa floor. Br J Neurosurg 12:2542581998

  • 5

    Goel A: Multilayer reconstruction of the middle fossa floor. Acta Neurochir (Wien) 138:5845891996

  • 6

    Goel A: Reconstructing the “skull base” divide. World Neurosurg 81:54552014

  • 7

    Goel A: Reconstruction of the skull base using locally available alternative: a review. Indian J Plast surg 25:57621995

  • 8

    Goel A: Use of outer layer of dura as a pedicled flap. Surg Neurol 44:92931995

  • 9

    Goel A: Vascularised bone flap for anterior skull base reconstruction. Acta Neurochir (Wien) 128:1661681994

  • 10

    Goel A: Vascularized osteomyoplastic flaps for skull base reconstruction. Br J Neurosurg 8:79821994

  • 11

    Goel AGahankari D: Extended subgaleal fascia—pericranial flap for anterior skull base reconstruction. Acta Neurochir (Wien) 135:2032051995

    • Search Google Scholar
    • Export Citation
  • 12

    Goel AGupta S: Reconstruction of the skull base: a review of personal techniques. Neurol India 48:2082152000

  • 13

    Goel AMuzumdar DP: Reconstruction of the sella floor using vascularized pedicled mucosal flap. Br J Neurosurg 17:5535552003

  • 14

    Goel ANitta JKobayashi SHongo KReconstruction of the skull base. Kobayashi SGoel AHongo K: Neurosurgery of complex Tumours and Vascular lesions New YorkChurchill Livingstone1997. 393414

    • Search Google Scholar
    • Export Citation
  • 15

    Zeiler FAKaufmann AM: Vascularized rotational temporal bone flap for repair of anterior skull base defects: a novel operative technique. J Neurosurg 123:131213152015

    • Search Google Scholar
    • Export Citation
  • 1

    Goel AAlternative methods for reconstruction of skull base bone using locally available alternatives. Torrens MJAl-Mefty AKobayashi S: Operative Skull Base Surgery New YorkChurchill Livingstone1997. 359372

    • Search Google Scholar
    • Export Citation
  • 2

    Goel A: Extended vascularised temporalis muscle-fascia flap. Br J Neurosurg 8:7317331994

  • 3

    Goel A: Long vascular pedicle cranial flap. Br J Neurosurg 9:6676701995

  • 4

    Goel A: Multilayer reconstruction of the anterior cranial fossa floor. Br J Neurosurg 12:2542581998

  • 5

    Goel A: Multilayer reconstruction of the middle fossa floor. Acta Neurochir (Wien) 138:5845891996

  • 6

    Goel A: Reconstructing the “skull base” divide. World Neurosurg 81:54552014

  • 7

    Goel A: Reconstruction of the skull base using locally available alternative: a review. Indian J Plast Surg 25:57621995

  • 8

    Goel A: Use of outer layer of dura as a pedicled flap. Surg Neurol 44:92931995

  • 9

    Goel A: Vascularised bone flap for anterior skull base reconstruction. Acta Neurochir (Wien) 128:1661681994

  • 10

    Goel A: Vascularized osteomyoplastic flaps for skull base reconstruction. Br J Neurosurg 8:79821994

  • 11

    Goel AGahankari D: Extended subgaleal fascia—pericranial flap for anterior skull base reconstruction. Acta Neurochir (Wien) 135:2032051995

    • Search Google Scholar
    • Export Citation
  • 12

    Goel AGupta S: Reconstruction of the skull base: a review of personal techniques. Neurol India 48:2082152000

  • 13

    Goel AMuzumdar DP: Reconstruction of the sella floor using vascularized pedicled mucosal flap. Br J Neurosurg 17:5535552003

  • 14

    Goel ANitta JKobayashi SHongo KReconstruction of the skull base. Kobayashi SGoel AHongo K: Neurosurgery of Complex Tumours and Vascular Lesions New YorkChurchill Livingstone1997. 393414

    • Search Google Scholar
    • Export Citation
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