title: Three-layer reconstruction for large defects of the anterior skull base.
abstract: OBJECTIVE
  To evaluate and discuss a three-layer rigid reconstruction technique for large anterior skull base defects.
  
  
  METHODS
  Prospective, nonrandomized, non-blinded.
  
  
  METHODS
  Tertiary teaching medical center.
  
  
  METHODS
  Twenty consecutive patients underwent craniofacial resection for a variety of pathology. All patients had large anterior cranial base defects involving the cribriform plate, fovea ethmoidalis, and medial portion of the roof of the orbit at least on one side. A few patients had more extensive defects involving both roof of the orbits, planum sphenoidale, and bones of the upper third of the face. The defects were reconstructed with a three-layer technique. A watertight seal was obtained with a pericranial flap separating the neurocranium from the viscerocranium. Rigid support was provided by bone grafts fixed to a titanium mesh, anchored laterally to the orbital roofs. All patients had a computed tomography scan of the skull on the first or second postoperative day. Patients were observed for immediate and long-term postoperative complications after such reconstruction.
  
  
  RESULTS
  Postoperative computed tomography scans showed small pneumocephalus in all patients. It resolved spontaneously and did not produce neurologic deficits in any patient. There was no cerebrospinal fluid leak, hematoma, or infection. On long-term follow-up, exposures of bone graft or mesh, brain herniation, or transmission of brain pulsation to the eyes were not observed in any patient.
  
  
  CONCLUSIONS
  Three-layer reconstruction using bone grafts, titanium mesh, and pericranial flap provides an alternative technique for repair of large anterior cranial base defects. It is safe and effective, and provides rigid protection to the brain.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Southern California School of Medicine, Los Angeles 90033, USA. sinha@hsc.usc.edu
authors.forename: Uttam K
authors.initials: UK
authors.lastname: Sinha
authors.forename: Terence E
authors.initials: TE
authors.lastname: Johnson
authors.forename: Dennis
authors.initials: D
authors.lastname: Crockett
authors.forename: Satish
authors.initials: S
authors.lastname: Vadapalli
authors.forename: Peter
authors.initials: P
authors.lastname: Gruen
mesh_terms: D000293:Adolescent; D000328:Adult; D016025:Bone Transplantation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D019292:Skull Base Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D013524:Surgical Flaps; D013526:Surgical Mesh; D014025:Titanium / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D014025:Titanium