Vascularized Mastoid Bone Flap Cranioplasty after Translabyrinthine Vestibular Schwannoma Surgery

Heng-Wai Yuen; Andrew L Thompson; Sean P Symons; Farhad Pirouzmand; Joseph M Chen

doi:10.1055/s-0028-1096204

Skull Base, Table of Contents

Skull Base 2009; 19(3): 193-201
DOI: 10.1055/s-0028-1096204

ORIGINAL ARTICLE

Vascularized Mastoid Bone Flap Cranioplasty after Translabyrinthine Vestibular Schwannoma Surgery

Heng-Wai Yuen¹ , Andrew L. Thompson² , Sean P. Symons² , Farhad Pirouzmand³ , Joseph M. Chen¹

¹Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
²Department of Diagnostic Radiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
³Department of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

Abstract

ABSTRACT

Objective: We describe a novel technique of cranioplasty using a vascularized mastoid bone flap in patients after translabyrinthine excision of vestibular schwannomas (VS). Postoperative outcomes in terms of pinna and postauricular deformity are evaluated. Study Design: Retrospective study. Setting: Tertiary referral center. Results: Seventeen patients underwent cranioplasty with bone flap after translabyrinthine VS excision. At minimum follow-up of 12 months, none had a cerebrospinal fluid (CSF) leak. The measured pinna projections between the operated and non-operated sides had a mean difference of 0.80 mm (±1.70), which is not statistically significant (p > 0.05). The mean depth of the postauricular depressions was 1.38 mm (±0.93). Over the same period, 10 patients underwent translabyrinthine VS surgery without cranioplasty. In this group, there was a significant difference of 4.71 mm (±1.53) in mean pinna underprojections on the operated sides compared with the non-operated sides. Compared with patients who have undergone cranioplasty, the retroauricular depressions were significantly deeper (p < 0.05) with a mean depth of 2.92 mm (±1.21) . Conclusions: Vascularized mastoid cortical bone flap cranioplasty is a simple and effective technique to ameliorate the pinna and retroauricular deformities after translabyrinthine VS excision without increased surgical cost or the use of alloplastic materials.

KEYWORDS

Vascularized bone flap - cranioplasty - vestibular schwannoma - mastoid reconstruction

Full Text

References

REFERENCES

1 Sanna M, Rohit M S, Skinner L J, Jain Y. Technique to prevent post-operative CSF leak in the translabyrinthine excision of vestibular schwannoma. J Laryngol Otol. 2003; 117 965-968
2 House J L, Hitselberger W E, House W F. Wound closure and cerebrospinal fluid leak after translabyrinthne surgery. Am J Otol. 1982; 4 126-128
3 Wazen J J, Sisti M, Lam S M. Cranioplasty in acoustic neuroma surgery. Laryngoscope. 2000; 110 1294-1297
4 Costantino P D, Friedman C D, Jones K, Chow L C, Pelzer H J, Sisson Sr G A. Hydroxyapatite cement. I. Basic chemistry and histologic properties. Arch Otolaryngol Head Neck Surg. 1991; 117 379-384
5 Kamerer D B, Hirsch B E, Snyderman C H. Hydroxyapatite cement: a new method of achieving watertight closure in transtemporal surgery. Am J Otol. 1994; 15 47-49
6 Costantino P D, Chaplin J M, Wolpoe M E et al.. Applications of fast-setting hydroxyapatite cement: cranioplasty. Otolaryngol Head Neck Surg. 2000; 123 409-412
7 Poetker D M, Pytynia K B, Meyer G A, Wackym P A. Complication rate of transtemporal hydroxyapatite cement cranioplasties: a case series review of 76 cranioplasties. Otol Neurotol. 2004; 25 604-609
8 Kveton J F, Friedman C D, Constantino P D. Indications for hydroxyapatite cement reconstruction in lateral skull base surgery. Am J Otol. 1995; 16 465-469
9 Arriaga M A, Chen D A, Burke E L. Hydroxyapatite cement cranioplasty in translabyrinthine acoustic neuroma surgery—update. Otol Neurotol. 2007; 28 538-540
10 Arriaga M A, Chen D A. Hydroxyapatite cement cranioplasty in translabyrinthine acoustic neuroma surgery. Otolaryngol Head Neck Surg. 2002; 126 512-517
11 Couldwell W T, Fukushima T. Cosmetic mastoidectomy for the combined supra/infratentorial transtemporal approach. J Neurosurg. 1993; 79 460-461
12 Tokoro K, Chiba Y, Murai M et al.. Cosmetic reconstruction after mastoidectomy for the transpetrosal-presigmoid approach: Technical note. Neurosurgery. 1996; 39 186-188
13 McCarthy J G, Zide B M. The spectrum of calvarial bone grafting: introduction of the vascularized calvarial bone flap. Plast Reconstr Surg. 1984; 74 10-18
14 Simpson D. Titanium in cranioplasty. J Neurosurg. 1965; 22 292-293
15 Gordon D S, Blair G A. Titanium cranioplasty. BMJ. 1974; 2 478-481
16 Fayad J N, Schwartz M S, Slattery W H, Brackmann D E. Prevention and treatment of cerebrospinal fluid leak after translabyrinthine acoustic tumor removal. Otol Neurotol. 2007; 28 387-390
17 Choung P H, Nam I W, Kim K S. Vascularized cranial bone grafts for mandibular and maxillary reconstruction. The parietal osteofascial flap. J Craniomaxillofac Surg. 1991; 19 235-242
18 Choung P H. The auriculomastoid fasciocutaneous island flap: a new flap for orofacial reconstruction. J Oral Maxillofac Surg. 1996; 54 559-567
19 Marty F, Montandon D, Gumener R, Zbrodowski A. Subcutaneous tissue in the scalp: anatomical, physiological and clinical study. Ann Plast Surg. 1986; 16 368-376

Joseph M ChenM.D.

Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto

2075 Bayview Avenue, M1-102, Toronto, ON M4N 3M5, Canada

Email: joseph.chen@sunnybrook.ca