Bilateral Inferior Turbinate Flap for Repair of Skull Base Dehiscence after Proton Beam Radiotherapy for Clival Chordoma

Clival chordomas are rare, aggressive, notochord-derived tumors with an incidence of approximately 8 per 10 million. Management consists of surgery, commonly with an endoscopic endonasal approach (EEA), and adjuvant proton beam radiotherapy. After resection, vascularized coverage of the ventral skull base is paramount to avoid complications such as cerebrospinal fluid (CSF) leak and meningitis. This is often achieved using a nasoseptal flap (NSF) at the time of initial surgery. NSF failure is estimated to occur in at least 2% of cases, requiring alternative options using flaps from the lateral nasal wall, temporoparietal fascia (TPF), nasal turbinates, or anterolateral thigh (ALT).