Design of a temporoparietal fascial flap after a spontaneous nasal fistula unresolved by conventional approaches.

We report the surgical management of a spontaneous and recurrent nasal fistula using a temporoparietal fascial flap for definitive treatment after several failed attempts to close the fistula by conventional approaches. Two formalin-fixed cadaveric human heads were also dissected to study the anatomy and surgical technique involved in the design of the temporoparietal fascial flap.

The limits of the endoscopic endonasal transclival approach for posterior fossa tumors.

Endoscopic endonasal approaches (EEA) have gained popularity and acceptance in skull base surgery over the last two decades. So-called expanded EEA allow access in the sagittal plane from the frontal sinus to the odontoid process. The endoscopic endonasal transclival approach allows a unique trajectory into the midline clivus and skull base that is unachievable from traditional craniotomy approaches to lesions such as chondrosarcomas, chordomas, and posterior fossa meningiomas. In this review, we will assess the benefits and drawbacks to using an endoscopic endonasal approach versus transcranial approach to these challenging lesions, assess the anatomical limits of endoscopic endonasal transclival surgery, and discuss the published literature on the topic.