Training cerebrospinal fluid leak repair with nasoseptal flap on the lamb's head.

Background: One of the major challenges of cranial base surgery is reconstruction of dural defects and cerebrospinal fluid leak closure. Various grafting methods have been used for smaller skull base defects with great success. The indications for endoscopic reconstruction have recently evolved to encompass much larger breeches in the skull base following tumor removal, thus emphasizing the need for vascularized tissue flaps for reconstruction.

Methods: Some authors proposed a pedicled flap of the nasal septum mucoperiosteum and mucoperichondrium, which is very vascularized and has quite a large surface. It is also long enough to easily cover even larger defects of the skull base. The elevation of a nasoseptal flap is based on a particularly advanced surgical technique and thus requires proper training before being performed in a real patient.

Results: Anatomical differences between human and lamb heads were observed and explained although they do not affect the procedure of the elevation of the nasoseptal flap.

Conclusions: The lamb's head has been shown to be an ideal model for the adequate training of the surgical skills required for this demanding procedure.