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DOI: 10.1055/s-2006-959333
A Comprehensive Algorithm for Anterior Skull Base Reconstruction after Oncological Resections
Publikationsverlauf
Publikationsdatum:
08. Januar 2007 (online)
ABSTRACT
Objective: To present our method for anterior skull base reconstruction after oncological resections. Methods: One hundred nine patients who had undergone 120 anterior skull base resections of tumors (52 malignant [43%], 68 benign [57%]) via the subcranial approach were studied. Limited dural defects were closed primarily or reconstructed using a temporalis fascia. Large anterior skull base defects were reconstructed by a double-layer fascia lata graft. A split calvarial bone graft, posterior frontal sinus wall, or three-dimensional titanium mesh were used when the tumor involved the frontal, nasal, or orbital bones. A temporalis muscle flap was used to cover the orbital socket for cases of eye globe exenteration, and a rectus abdominis free flap was used for subcranial-orbitomaxillary resection. Pericranial flap wrapping of the frontonaso-orbital segment was performed to prevent osteoradionecrosis if perioperative radiotherapy was planned. Results: The incidence of cerebrospinal fluid (CSF) leak, intracranial infection, and tension pneumocephalus was 5%. Histopathological and immunohistochemical analysis of fascia lata grafts in reoperated patients (n = 7) revealed integration of vascularized fibrous tissue to the graft and local proliferation of a newly formed vascular layer embedding the fascial sheath. Conclusion: A double-layer fascial graft alone was adequate for preventing CSF leak, meningitis, tension pneumocephalus, and brain herniation. We describe a simple and effective method of anterior skull base reconstruction after resections of both malignant and benign tumors.
KEYWORDS
Craniofacial - CSF leak - pneumocephalus - neoplasms - cranial base - malignant tumors
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Ziv GilM.D. Ph.D.
Dan M FlissM.D.
Department of Otolaryngology-Head and Neck Surgery, Tel-Aviv Sourasky Medical Center
Tel-Aviv University, 6 Weizman St., Tel-Aviv 64239, Israel
eMail: ziv@dot.co.il
eMail: fliss@tasmc.health.gov.il