Skull base reconstruction

Abstract

Reconstruction of skull base defects following tumor resection is of paramount importance in avoiding serious and life-threatening complications. Cranial base surgery has evolved and outcomes have steadily improved as increasingly reliable reconstructive techniques have been adapted to repair the challenging wounds in this complex anatomic region. The most significant development has been the introduction and refinement of microvascular free tissue transfer to the skull base over the past 15 to 20 years. Free flaps can reliably provide the requisite tissue to not only seal the intracranial space from the subjacent cavities, but also to restore complex craniofacial defects that often result from skull base tumor excision. Advances in alloplast technology have also expanded the armamentarium available to the reconstructive surgeon. In particular, bone substitutes, titanium hardware, and resorbable plate fixation have been shown to be very efficacious when used in carefully selected situations. Finally, tissue sealants and adhesives have become widely used as an adjunctive method to achieve a water-tight dural repair.

Intracranial application of free fasciocutaneous flaps in a novel sandwich technique for skull base reconstruction

“…Surg. 2011; 40: 931-937 doi:10.1016/j.ijom.2011.05.013, available online at http://www.sciencedirect.com tissue transfer 13 . The transfer of highly vascularized tissue optimizes primary wound healing and thus can also be used in irradiated sites or in patients who will receive postoperative radiotherapy.…”

“…Complications, such as failure of primary wound healing, flap loss, CSF leakage, and secondary complications are significantly lower in free tissue transfer compared with regional flaps 24 . Over the past years, free tissue transfer has become the treatment of choice in extensive skull base reconstruction 2,5,7,8,13,24,26 .…”

Update on the Surgical Management of Temporomandibular Joint–Centered Tendon Sheath Giant Cell Tumor With Intradural Extension

“…The potential of direct communication between dura and extracranial cannot be overemphasized, particularly in cases requiring dura grafting. Persistent CSF leak poses a threat for meningitis (8.6%-41%), 9 which can be life threatening. Thereby, ideal skull base reconstruction required reliable and voluminous tissue.…”

“…However, the muscle undergoes an unpredictable amount of denervation atrophy over time. 9 The contracture and atrophy of the temporalis muscle will be deficient for long-term bone support. In addition, autologous bone grafting is a reliable plug for rigid support in preventing brain hernia and CSF leak.…”

Analysis of Morbidity and Mortality in Patients Undergoing Skull Base Reconstruction

“…1 Numerous reconstruction methods have been used, and their pros and cons have been examined. [2][3][4] Developments in surgical technique have made it possible to operate on lesions that were previously deemed inoperable. 5 However, despite these technical advancements in addition to improved preoperative radiographic assessment of tumor extent and postoperative care, complications remain an inherent occurrence in this patient population.…”