Skull base reconstruction following anterior subcranial resection

The technical approach for skull base surgery has progressed considerably during the last decade. However, 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. The purpose of this study was to present a simplified approach to skull base reconstruction. The study reports our experience of 94 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-54 cases, temporalis fascia-27 cases, temporalis muscle-8 cases, and gallea frontalis-5 cases. Bony defects were restructured with the use of external calvarial table graft, posterior frontal sinus wall (6 and 4 cases, respectively) and Hydroxyapatite paste in 11 cases. It is concluded that fascia lata and temporalis fascia provide simple and reliable reconstruction materials for the base of skull. Accordingly, this procedure results in a low rate of CSF leakage, intracranial infections, and sinus dysfunction.