Skull base reconstruction after anterior subcranial tumor resection.
OBJECTIVE
The goal of this study was to demonstrate the efficacy of a simple and reliable technique for anterior skull base and craniofacial reconstruction in patients who have undergone excision of tumors via the subcranial approach.


METHODS
There were 63 patients who had undergone 71 anterior skull base resections of tumors via the aforementioned approach. Twenty-nine cases (41%) involved malignant tumors and 42 (59%) involved benign tumors. Reconstruction of the anterior skull base was performed by a single team who used double-layer fascial graft. Limited dural defects were reconstructed using the temporalis fascia, whereas large anterior skull base defects were reconstructed using a fascia lata sheath. Reconstruction was achieved without the support of bone graft or titanium mesh and without pericranial, galeal, or free flaps. Pericranial flap wrapping of the frontonasoorbital segment was performed to prevent osteoradionecrosis if postoperative radiotherapy was planned. The incidence of cerebrospinal fluid (CSF) leakage, intracranial infection, and tension pneumocephalus was 5.6%. Histopathological examination of fascia lata grafts obtained in patients who had undergone a second procedure demonstrated integration of vascularized fibrous tissue to the graft, as well as local proliferation of a newly formed vascular layer embedding the fascial sheath.


CONCLUSIONS
The use of a double-layer fascial graft alone was adequate for prevention of CSF leakage, meningitis, tension pneumocephalus, and brain herniation. The double-layer fascial flap provided a simple and reliable means for anterior skull base reconstruction after en bloc resection of both malignant and benign tumors.
Fliss
Dan M
DM
Department of Otolaryngology-Head and Neck Surgery, Institute of Pathology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. fliss@tasmc.health.gov.il
Gil
Ziv
Z
Spektor
Sergey
S
Leider-Trejo
Leonor
L
Abergel
Avraham
A
Khafif
Avi
A
Amir
Aharon
A
Gur
Eyal
E
Cohen
Jacob T
JT
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002558:Cerebrospinal Fluid Otorrhea / Q000517:prevention & control; D002559:Cerebrospinal Fluid Rhinorrhea / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004388:Dura Mater / Q000601:surgery; D004677:Encephalocele / Q000517:prevention & control; D005205:Fascia / Q000637:transplantation; D005260:Female; D006801:Humans; D008297:Male; D008581:Meningitis / Q000517:prevention & control; D008875:Middle Aged; D010025:Osteoradionecrosis / Q000517:prevention & control; D011007:Pneumocephalus / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D019736:Prostheses and Implants; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome