{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T05:43:40Z","timestamp":1792475020398,"version":"4.5.0"},"reference-count":25,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2024,11,28]],"date-time":"2024-11-28T00:00:00Z","timestamp":1732752000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: To evaluate the outcomes of anterior skull base (ASB) reconstruction using single versus double vascularized flap techniques following multiportal cranio-endoscopic approaches (CEA), based on a 12-year experience. Methods: A retrospective analysis was conducted on 46 patients who underwent ASB reconstruction after a CEA at our department between 2010 and 2022. Patients were divided into two groups: Group 1 received a pericranial flap (PF) reinforced with a fascia graft, while Group 2 underwent multiple flap reconstruction with PF, fascia graft, and nasoseptal flap (NSF). The primary outcome measured was the incidence of cerebrospinal fluid (CSF) leakage and the impact of adjuvant radiotherapy (RT) on reconstruction. Results: Group 1 (86.9%) demonstrated no significant postoperative CSF leaks, showing that the PF, combined with multilayer techniques (including underlay sealing matrix and overlay fascia graft), effectively repaired ASB defects. Group 2 (13.1%), employing both PF and NSF, showed similar outcomes, with the dual flap approach particularly beneficial in cases of post-traumatic fistulas or when the nasal septum was spared by disease. No significant differences were observed in complications or flap necrosis, even in patients receiving adjuvant RT. Conclusions: The PF is a reliable and versatile option for ASB reconstruction, often sufficient as a single-flap technique. The addition of an NSF can be beneficial in specific cases, particularly in post-traumatic conditions or tumors with unilateral endonasal invasion. However, PF alone, when combined with a multilayer approach, minimizes the risk of CSF leakage and long-term flap necrosis, underscoring the importance of tailored surgical strategies for optimal outcomes.<\/jats:p>","DOI":"10.3390\/jcm13237229","type":"journal-article","created":{"date-parts":[[2024,11,28]],"date-time":"2024-11-28T07:28:01Z","timestamp":1732778881000},"page":"7229","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Anterior Skull Base Reconstruction in Multiportal Approaches: Insight into Vascularized Flap Techniques"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9287-5239","authenticated-orcid":false,"given":"Luca","family":"Ferlendis","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Luigi Borri, 57, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca","family":"Bossi","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Luigi Borri, 57, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Tabano","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Luigi Borri, 57, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lidia","family":"Bifone","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Luigi Borri, 57, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8916-6562","authenticated-orcid":false,"given":"Alberto Daniele","family":"Arosio","sequence":"additional","affiliation":[{"name":"Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Luigi Borri, 57, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4447-9570","authenticated-orcid":false,"given":"Paula Nathalie","family":"Espinoza Apolo","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Luigi Borri, 57, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6016-0573","authenticated-orcid":false,"given":"Fabio","family":"Pozzi","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Luigi Borri, 57, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Coden","sequence":"additional","affiliation":[{"name":"Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Luigi Borri, 57, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Bignami","sequence":"additional","affiliation":[{"name":"Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Luigi Borri, 57, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5184-6140","authenticated-orcid":false,"given":"Paolo","family":"Castelnuovo","sequence":"additional","affiliation":[{"name":"Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Luigi Borri, 57, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1163-9611","authenticated-orcid":false,"given":"Davide","family":"Locatelli","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Luigi Borri, 57, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1007\/s00701-014-2174-x","article-title":"Primary dural closure and anterior cranial base reconstruction using pericranial and nasoseptal multi-layered flaps in endoscopic-assisted skull base surgery","volume":"156","author":"Tomio","year":"2014","journal-title":"Acta Neurochir."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1007\/s00701-019-04155-1","article-title":"Efficacy of simultaneous pericranial and nasoseptal \u201cdouble flap\u201d reconstruction of anterior skull base defects after combined transbasal and endoscopic endonasal approaches","volume":"162","author":"Gabriel","year":"2020","journal-title":"Acta Neurochir."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1055\/s-2005-922095","article-title":"Endoscopic 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Forum Allergy Rhinol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/23\/7229\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:41:29Z","timestamp":1760114489000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/23\/7229"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,28]]},"references-count":25,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["jcm13237229"],"URL":"https:\/\/doi.org\/10.3390\/jcm13237229","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,28]]}}}