Free flap reconstruction of tumors involving the cranial base

Abstract

The authors describe their experience in treating 24 patients who underwent resection of tumors involving anterior, middle or posterior cranial fossa with immediate reconstruction. All were reconstructed with free flaps, 15 rectus abdominis, 4 radial forearm, 3 latissimus dorsi, 2 great omentum, and one scapular flap. There was one latissimus dorsi flap loss due to arterial thrombosis in a heavily irradiated patient. Three patients presented with a temporary cerebrospinal fluid leak, one of them with meningitis which resolved after intravenous antibiotics and continuous lumbar drainage. Fifteen patients were followed (mean 2 years). Five died of recurrence. Four presented local recurrence. Six patients are alive with no signs of recurrence. Free flaps, especially the rectus abdominis flap and the latissimus dorsi, are versatile flaps and may be easily positioned to cover several structures or anatomical surfaces.

Microvascular Reconstruction of the Skull Base: A Clinical Approach to Surgical Defect Classification and Flap Selection

“…As a result, free tissue transfer has become widely accepted as the best method of reconstructing defects of the skull base. 11,[20][21][22][23][24][25][26] Anterior cranial fossa resection begins with a bifrontal craniotomy, followed by facial exposure via a Weber-Fergusson incision, with or without subciliary extension. 19 Once the tumor has been resected with tumor-free margins, reconstruction of the anterior skull base defect can proceed.…”

Free tissue transfer and local flap complications in anterior and anterolateral skull base surgery

“…5,6,8,20,28 The most frequent complications in these reports are acute problems related to surgical closure, such as hematoma, CSF leak, and flap loss. In the recent reports in which a preponderance of local flaps were used, the complications were related more to the healing of the wound.…”

“…4À7 Many massive tumors involving the intracranial, sinonasal, orbital, and oral cavities, as well as overlying skin, that were previously deemed unresectable are routinely resected today. 8 The earliest reconstructions of anterior craniofacial resections consisted of relining all denuded surfaces of the sinonasal cavity, including the exposed or patched dura, with a skin graft.…”

Reconstrução da base do crânio

“…Besteiro e col. descreveram sua experiência em 24 pacientes submetidos à ressecção de tumores que envolviam as fossas anterior, média e posterior com reconstrução imediata com retalhos livres de reto abdominal em 15 pacientes, radial do antebraço em quatro pacientes, latissimus dorsi em três pacientes, omento maior em dois pacientes e escapular em um paciente. Eles descreveram que os retalhos livres, especialmente o retalho de reto abdominal e latissimus dorsi são versáteis e podem ser facilmente posicionados para recobrir inúmeras estruturas ou superfícies anatômicas 3 .…”