Seminars in Plastic Surgery 2017; 31(04): 189-196
DOI: 10.1055/s-0037-1607273
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Open Anterior Skull Base Reconstruction: A Contemporary Review

Daniel Kwon
1  Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California
,
Alfred Iloreta
2  Division of Rhinology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
,
Brett Miles
3  Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
,
Jared Inman
1  Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California
› Author Affiliations
Further Information

Publication History

Publication Date:
25 October 2017 (online)

Abstract

Skull base extirpative and reconstructive surgery has undergone significant changes due to technological and operative advances. While endoscopic resection and reconstruction will continue to advance skull base surgery for the foreseeable future, traditional open surgical approaches and reconstructive techniques are still contemporarily employed as best practices in certain tumors or patient-specific anatomical cases. Skull base surgeons should strive to maintain a working knowledge and technical skill set to manage these challenging cases where endoscopic techniques have previously failed, are insufficient from anatomical constraints, or tumor biology with margin control supersedes the more minimally invasive approach. This review focuses on the reconstructive techniques available to the open skull base surgeon as an adjunct to the endoscopic reconstructive options. Anatomic considerations, factors relating to the defect or patient, reconstructive options of nonvascular grafts, local and regional flaps, and free tissue transfer are outlined using the literature and author's experience. Future directions in virtual surgical planning and emerging technologies will continue to enhance open and endoscopic skull base surgeon's preparation, performance, and outcomes in this continually developing interdisciplinary field.