{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T03:02:45Z","timestamp":1777950165099,"version":"3.51.4"},"reference-count":9,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"vor","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum D\u00fcsseldorf. Anstalt \u00f6ffentlichen Rechts"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Neurochir"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sinonasal inverted papilloma (SNIP) is histologically benign but locally aggressive, with high recurrence rates and a relevant risk of malignant transformation. Tumor involvement of the nasal root and overlying skin may result in a full-thickness craniofacial defect with direct intracranial\u2013external communication. Reconstruction is particularly challenging after failure of conventional skull base techniques (e.g., titanium mesh and pericranial flaps), which may lead to pneumocephalus, cerebrospinal fluid (CSF) leakage, and infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe a multidisciplinary staged salvage strategy combining bifrontal craniotomy with a vascularized anterolateral thigh (ALT) free flap for definitive reconstruction of complex anterior skull base and nasion defects after failed conventional reconstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We report a recurrent SNIP case with failed initial skull base reconstruction. After infection control and resolution of pneumocephalus, an ALT free flap was used. The pedicle was routed transcranially through an enlarged skull base defect to temporal recipient vessels, enabling three-layer reconstruction from dura to skin and restoration of nasal dorsum contour.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Definitive reconstruction was completed in 7\u00a0h. The flap survived without vascular compromise. During the postoperative course and early follow-up, no CSF leak, infection, or recurrent pneumocephalus was observed. Stable intracranial\u2013extracranial separation and satisfactory functional\/aesthetic outcomes were achieved.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Bifrontal re-exploration followed by staged ALT free-flap reconstruction represents a viable salvage option for complex anterior skull base defects after failed primary repair. In our experience, transcranial pedicle routing and a three-layer reconstruction approach can facilitate effective intracranial-extracranial separation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00701-026-06895-3","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T14:45:16Z","timestamp":1777646716000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Vascularized anterolateral thigh free flap for salvage reconstruction of complex anterior skull base and nasion defects after failed conventional reconstruction\u2014 how I do it"],"prefix":"10.1007","volume":"168","author":[{"given":"Hongjun","family":"Liu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix","family":"Knapp","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f6rg","family":"Schipper","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katharina","family":"Faust","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sajjad","family":"Muhammad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,5,1]]},"reference":[{"issue":"2","key":"6895_CR1","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1055\/s-0040-1718909","volume":"83","author":"RP Dang","year":"2021","unstructured":"Dang RP, Ettyreddy AR, Rizvi Z et al (2021) Free flap reconstruction of the anterior skull base: a systematic review. J Neurol Surg B Skull Base 83(2):125\u2013132. https:\/\/doi.org\/10.1055\/s-0040-1718909","journal-title":"J Neurol Surg B Skull Base"},{"issue":"6","key":"6895_CR2","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1055\/s-0036-1583310","volume":"77","author":"M Geyik","year":"2016","unstructured":"Geyik M, Erkutlu I, Alptekin M et al (2016) Anterior skull base defects reconstructed using three-layer method: 78 consecutive cases with long-term follow-up. J Neurol Surg B Skull Base 77(6):499\u2013502. https:\/\/doi.org\/10.1055\/s-0036-1583310","journal-title":"J Neurol Surg B Skull Base"},{"issue":"2","key":"6895_CR3","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1097\/MOO.0000000000000233","volume":"24","author":"RA Hachem","year":"2016","unstructured":"Hachem RA, Elkhatib A, Beer-Furlan A et al (2016) Reconstructive techniques in skull base surgery after resection of malignant lesions: a wide array of choices. Curr Opin Otolaryngol Head Neck Surg 24(2):91\u201397. https:\/\/doi.org\/10.1097\/MOO.0000000000000233","journal-title":"Curr Opin Otolaryngol Head Neck Surg"},{"issue":"1","key":"6895_CR4","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1002\/lary.26222","volume":"127","author":"JS Kim","year":"2017","unstructured":"Kim JS, Kwon SH (2017) Recurrence of sinonasal inverted papilloma following surgical approach: a meta-analysis. Laryngoscope 127(1):52\u201358. https:\/\/doi.org\/10.1002\/lary.26222","journal-title":"Laryngoscope"},{"issue":"2","key":"6895_CR5","doi-asserted-by":"publisher","first-page":"242","DOI":"10.3390\/cancers16020242","volume":"16","author":"K Kraimer","year":"2024","unstructured":"Kraimer K, Geltzeiler M (2024) Skull base reconstruction by subsite after sinonasal malignancy resection. 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