Novel Vascularized Pedicle Flaps for Dural Reconstruction via Endoscopic Transorbital Approach: Temporalis Muscle and Pericranial Flaps

BACKGROUND: The endoscopic transorbital approach (ETOA) has emerged as a valuable minimally invasive technique in skull base surgery, providing direct access to the anterior and middle cranial fossae. However, effective reconstruction of dural defects remains a significant technical challenge. This study evaluates the feasibility and anatomical characteristics of temporalis muscle flaps (TFs) and pericranial flaps (PFs) for dural reconstruction following ETOA, using cadaveric models. METHODS: Four fresh cadaveric heads were dissected. The TFs were harvested using an inferior-based pedicle, whereas the PFs were obtained endoscopically. Flap dimensions were measured and reported as median and range. RESULTS: The TFs demonstrated consistent dimensions, with a median caudal length of 20.75 mm (range 20-22) and a median lateral width of 21.25 mm (range 20-23). PFs exhibited greater variability, with a mean length of 97.75 mm and a mean width of 54 mm. These findings suggest that TFs are optimal for defects centered on the temporal dura, whereas PFs offer broader, customizable coverage for larger or more complex reconstructions. CONCLUSIONS: Both TFs and PFs are feasible options for dural reconstruction following ETOA, providing robust vascularization and adaptability to defect size and location. Further clinical studies are warranted to validate their application in live surgical settings.