A comprehensive algorithm for anterior skull base reconstruction after oncological resections

Ziv Gil, Avraham Abergel, Leonor Leider-Trejo, Avi Khafif, Nevo Margalit, Aharon Amir, Eyal Gur, Dan M. Fliss

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To present our method for anterior skull base reconstruction after oncological resections. Methods: One hundred nine patients who had undergone 120 anterior skull base resections of tumors (52 malignant [43%], 68 benign [57%]) via the subcranial approach were studied. Limited dural defects were closed primarily or reconstructed using a temporalis fascia. Large anterior skull base defects were reconstructed by a double-layer fascia lata graft. A split calvarial bone graft, posterior frontal sinus wall, or three-dimensional titanium mesh were used when the tumor involved the frontal, nasal, or orbital bones. A temporalis muscle flap was used to cover the orbital socket for cases of eye globe exenteration, and a rectus abdominis free flap was used for subcranial-orbitomaxillary resection. Pericranial flap wrapping of the frontonaso-orbital segment was performed to prevent osteoradionecrosis if perioperative radiotherapy was planned. Results: The incidence of cerebrospinal fluid (CSF) leak, intracranial infection, and tension pneumocephalus was 5%. Histopathological and immunohistochemical analysis of fascia lata grafts in reoperated patients (n = 7) revealed integration of vascularized fibrous tissue to the graft and local proliferation of a newly formed vascular layer embedding the fascial sheath. Conclusion: A double-layer fascial graft alone was adequate for preventing CSF leak, meningitis, tension pneumocephalus, and brain herniation. We describe a simple and effective method of anterior skull base reconstruction after resections of both malignant and benign tumors.

Original languageEnglish
Pages (from-to)25-37
Number of pages13
JournalSkull Base
Volume17
Issue number1
DOIs
StatePublished - Jan 2007

Keywords

  • CSF leak
  • Cranial base
  • Craniofacial
  • Malignant tumors
  • Neoplasms
  • Pneumocephalus

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