Use of titanium mesh for reconstruction of large anterior cranial base defects

Abstract

The authors evaluated the role of titanium mesh used in combination with vascularized pericranium to provide rigid support during reconstruction of anterior skull base defects. Thirteen patients with large anterior skull base defects caused by tumor invasion or traumatic injury involving the cribriform plate, orbital roof, and planum sphenoidale were included in the study. The reconstruction technique involved placement of titanium mesh between two layers of continuous vascularized pericranium. Surgical glue and routine lumbar cerebrospinal fluid (CSF) drainage were not used in any patient. At a mean postoperative follow-up time of 22 months (range 8-39 months), none of the patients had developed infection or meningocele. Postoperative CSF rhinorrhea occurred in two patients with extensive dural defects, which resolved with temporary lumbar drainage. Use of titanium mesh and a two-layer vascularized pericranial graft is a safe, reproducible, and feasible method for reconstructing the anterior skull base. Patients with large dural defects may need temporary CSF diversion to avoid postoperative fistula formation.

Osteointegration of a Bisphenol-a-Glycidyl-Dimethacrylate Composite and Its Use in Anterior Skull Base Defects

“…However, the best method of achieving this is still debated. [5][6][7][8][9][10] Helms and Geyer 11 emphasized the importance of the bony defect closure in addition to the dural repair to prevent CSFLs. They suggested using allografts that strongly hold to the surrounding bone, so that a watertight closure of the skull base bone defect may be achieved.…”

Contemporary skull base reconstruction

“…Importantly, in neither study had the patients undergone previous surgery or radiation. Interestingly, Badie et al [11] also studied the use of titanium mesh and a pericranial flap alone without fibrin glue to repair large anterior floor defects. Using this strategy, the authors reported a cerebrospinal fluid leak rate of 15%.…”

Anterior skull base reconstruction: a review of current techniques

“…Whereas nonvascularized bone grafts, alloplastic implants, and HAC successfully reconstruct small bony defects, titanium mesh is well suited for reconstructing large areas requiring structural support to prevent meningoencephalocele [13,23]. Desirable properties include lack of donor site morbidity, malleability, biologic inertness, and MRI compatibility [23,24].…”