Pediatric Anterior Skull Base Reconstruction With Bilateral Temporoparietal Fascial Flap

Emphasis in ASB reconstruction is placed on achieving a watertight dural closure, providing structure for cranial and orbital contents, obliterating dead space, and separation between cranial and sinonasal contents in order to maintain a functional sinonasal system. Pediatric ASB reconstruction also requires consideration for future craniofacial skeletal growth, donor-site morbidity, and psychosocial impact when selecting a reconstructive donor site. Large defects (>3 cm) have traditionally been repaired with free flaps. We describe the successful use of bilateral temporoparietal fascia flaps for a large anterior skull base defect in a pediatric patient after tumor resection. Utilizing bilateral, stacked temporoparietal fascia flaps, which are regionally close to the ASB, avoids morbidity from both extraneous incisions and free flap transfer. The authors show that temporoparietal fascia flaps provide enough tissue bulk and vascularity for safe and effective use in pediatric ASB reconstruction.