Skull base reconstruction following anterior subcranial resection-outcome and complications

Jacob Tcohen, Ziv Gil, Gideon Zucker, Eyal Gur, Albert Gatot, Sergey Spektor, Dan M. Fliss

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: The technical approach for skull base surgery has progressed considerably during the last decade. How-ever, there is no single accepted method for reconstruction of skull base defects following anterior skull base resection. Skull base reconstruction is required to provide support to the frontal lobes, to construct a barrier to avoid CSF leak, to prevent pneumocephalus, and to eliminate intracranial spread of nasopharyngeal bacteria. Objective: The purpose of this study was to present a simplified approach to skull base reconstruction. The study reports our experience of 126 anterior skull base reconstruction procedures. The patients underwent tumor excision, reduction of complex fronto-naso-orbital and skull base fractures, repair of CSF leaks and extirpation of anterior skull base fungal infections through the extended subcranial approach. Skull base defects were reconstructed with multi-layered fascia lata (63 cases), temporalis fascia (28 cases), temporalis muscle (8 cases), and gallea frontalis (5 cases). In two cases of osteomyelitis and osteoradionecrosis reconstruction was done using free flaps (Reclus abdominis and latissimus dorsi). Bony defects were restructured with the use of external calvarial table graft, posterior frontal sinus wall (6 and 5 cases respectively), bone source in 13 cases, and titanium mesh in one patient. Results: There was no CSF leak, two patients had meningitis, one patient developed tension pneumocephalus and one developed intracranial hematoma. Conclusion: The fascia lata and temporalis fascia provides a simple and reliable reconstruction material for the base of skull. Accordingly, this procedure results in a low rate of CSF leakage, intracranial infections, and sinus dysfunction.

Original languageEnglish
Pages (from-to)58
Number of pages1
JournalSkull Base
Volume11
Issue numberSUPPL. 2
StatePublished - 2001

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