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.
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.
Authors: J Raveh; J B Turk; K Lädrach; R Seiler; N Godoy; J Chen; J Paladino; M Virag; K Leibinger Journal: J Neurosurg Date: 1995-06 Impact factor: 5.115
Authors: Joseph Califano; Peter G Cordeiro; Joseph J Disa; David A Hidalgo; Wilson DuMornay; Mark H Bilsky; Philip H Gutin; Jatin P Shah; Dennis H Kraus Journal: Head Neck Date: 2003-02 Impact factor: 3.147
Authors: Irit Duek; Alon Pener-Tessler; Ravit Yanko-Arzi; Arik Zaretski; Avraham Abergel; Ahmad Safadi; Dan M Fliss Journal: J Neurol Surg B Skull Base Date: 2018-01-05
Authors: Hedyeh Ziai; Eugene Yu; Terence Fu; Nidal Muhanna; Eric Monteiro; Allan Vescan; Gelareh Zadeh; Ian J Witterick; David P Goldstein; Fred Gentili; John R de Almeida Journal: J Neurol Surg B Skull Base Date: 2017-12-29
Authors: Omer J Ungar; Avraham Abergel; Ahmad Safadi; Arik Zaretzki; Ravit Yanko-Arzi; Dan M Fliss Journal: J Neurol Surg B Skull Base Date: 2019-02-06