An Algorithm of the Frontal Skull Base Reconstruction

Introduction: The usage of vascularized flaps in the treatment of nonhealing wounds is well known. Certain neurosurgical nosologies could be viewed as internal wound healing problems. Recurrent CSF-rhinorrhea due to frontobasal disintegrity is one of those unyielding internal wound-healing problems. Bringing vascularized tissue to an internal nonhealing wound bed is a possible solution for the treatment of such difficult cases. The closure of morphological frontobasal disintegrity may be treated by local, regional, and free vascularized tissue flaps. Our objective is to present a series of neurosurgical cases where vascularized tissue transfer found successful application.

Material and Methods: We treated six patients with recurrent frontobasal CSF leakage using the free vascularized tissue transfer technique. All these patients were operated several times using conventional methods. In two of the six patients the recurrent intractable frontobasal disintegrity was a result of craniocerebral trauma (gunshot wound and automobile accident). One patient incurred this problem after initial decompression of the optic nerve due to Cruzon's craniosynostosis. In the rest the cause was encroaching skull base tumors. In the first two patients free vascularized latissimus dorsi muscle flap and omentum were used for lining the frontal base. In the other patients we used a free vascularized fascia lata muscle. The choice of the flap was based on the form and extent of the defects.

Results: None of the cases developed further recurrences.

Conclusions: Vascularized tissue has better and long lasting mechanical properties and is resistant to bacterial invasion in comparison to its nonvascularized analogues. In neurosurgical practice one may keep open the option of free vascularized tissue transfer in difficult unyielding internal wound healing problems as described here.