Reconstructive techniques in skull base surgery after resection of malignant lesions

Abstract

Resection of skull base tumors, often creating large dural defects that couple with extensive intradural dissection, involving multiple cisterns or the third ventricle, may lead to high-flow cerebrospinal fluid leaks. Reconstruction of the skull base is paramount to achieve an uncomplicated postoperative course. Repair of small dural defects can be reliably achieved using a multilayer grafting technique, which yields a high success rate (>90%). Repair of larger defects associated with a high-flow cerebrospinal fluid leak, or defects in previously irradiated fields, often requires a local or regional pedicled vascularized graft as the first reconstructive choice. When these are unavailable, free microvascular tissue transfer remains an option.

Salvage skull base reconstruction in the endoscopic era: Vastus lateralis free tissue transfer

“…The primary goal of anterior cranial base reconstruction is to separate the intracranial and extracranial compartments, achieving a watertight seal to prevent CSF leaks . This may be achieved via different combinations of free grafts, local flaps, regional flaps, and free tissue transfers . Microvascular reconstruction of the skull base has been well reported in the literature, and a myriad of donor sites have been described to achieve successful skull base reconstruction, although the rectus and radial forearm donor sites are most commonly cited .…”

“…As the techniques for expanded endonasal approaches have advanced, so have the development of local and regional flap reconstruction. The majority of skull base defects are successfully reconstructed with a combination of free grafts, local flaps, and regional flaps …”

Multimodal strategy for the management of sphenoid osteoradionecrosis: Preliminary results

“…There are relatively few studies on sphenoid ORN but it appears to be a life‐threatening condition, with reported survival rates as low as 33% . Several treatment regimen have been described, including conservative management with antibiotherapy or hyperbaric oxygen and more aggressive approaches such as surgical debridement of the necrotic tissues followed by protection of the exposed bone by local or free flaps . However, the extent of ORN may be very variable, and it seems difficult to use a single approach for the management of the various stages of the disease.…”

Radio‐anatomical analysis of the pericranial flap “money box approach” for ventral skull base reconstruction

“…Preoperative radiological analysis can be helpful in designing the PCF size and guiding the surgeon to properly estimate where incisions are best placed to avoid flaps miscalculation. The PCF might be an option for skull base reconstruction when the nasoseptal flap is not available and postoperative radiotherapy is planned …”