AANS Neurosurgeon | Volume 28, Number 3, 2019

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New Twist on Old Surgical Technique Helps Repair Patient’s Skull Base

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A Rutgers-led team of surgeons developed a groundbreaking procedure based on a century-old plastic surgery technique, to save the life of a patient who suffered complications following the removal of a cancerous tumor inside his skull.

The patient had a quarter-sized hole in his skull base, which separates the brain from the nasal cavity – an unfortunately common problem in patients who undergo surgery in that part of the skull. The hole caused air to build up inside the patient’s cranial cavity, cerebrospinal fluid to leak into the nose, and meningitis, according to a new report.

The Rutgers-led solution took a paramedian forehead flap – an age-old procedure in which a section of skin and muscle is cut away from the forehead and rotated downward, traditionally to reconstruct part of the nose. But for this patient, they used an endoscope to insert the flap of forehead tissue inside the patient’s head through an incision above his nose, then attached it to the skull base where it successfully closed the hole.

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