Anterior skull base reconstruction with a galeal-pericranial flap.
Excision of neoplasm and trauma involving the anterior cranial base may often result in communication between the intracranial and extracranial compartments. Many techniques have been proposed to obtain a watertight separation. We report our 5 years of experience in the management of anterior skull base defects using a galeal-pericranial flap. Between January 2001 and April 2006, 22 patients were treated for a cranial base reconstruction at the University of Messina. Five of them presented with persistent cerebrospinal fluid (CSF) leak after previous craniofacial trauma. Ten underwent a combined maxillofacial-neurosurgical approach for the removal of a benign tumor involving the anterior skull base. Seven had severe craniofacial trauma, which required an intervention of reconstruction of the anterior skull base. In the whole series, a galeal-pericranial flap was used to separate intra- and extracranial compartments. No patients developed postoperative brain contusions or subdural-epidural blood collections. Throughout the follow-up period, there was no evidence of flap failure. In all but one patient, no postoperative CSF leak was evident. In one patient, a mild transient postoperative CSF leakage was present. There has been no recurrent CSF leak or meningitis. The follow up average of 23 months shows no incidence of infection. Even if our series does not comprise malignancies and previously irradiated patients, our data confirm the validity of the galeal- pericranial flap for the surgical management of minimal and moderately sized defects of anterior cranial base.
Siniscalchi
Enrico Nastro
EN
Department of Maxillo-Facial Surgery and the Department of Neurosurgery, University of Messina, Messina, Italy.
Angileri
Filippo Flavio
FF
Mastellone
Paola
P
Catalfamo
Luciano
L
Giusa
Maria
M
Conti
Alfredo
A
De Ponte
Francesco Saverio
FS
Tomasello
Francesco
F
D000328:Adult; D035262:Cranial Fossa, Anterior / Q000601:surgery*; D006259:Craniocerebral Trauma / Q000601:surgery; D003399:Craniotomy; D005151:Facial Injuries / Q000601:surgery; D005205:Fascia / Q000637:transplantation*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000601:surgery; D013353:Subdural Effusion / Q000601:surgery; D013524:Surgical Flaps; D014014:Tissue Adhesives / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives