title: A comprehensive algorithm for anterior skull base reconstruction after oncological resections.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Ziv
authors.initials: Z
authors.lastname: Gil
authors.forename: Avraham
authors.initials: A
authors.lastname: Abergel
authors.forename: Leonor
authors.initials: L
authors.lastname: Leider-Trejo
authors.forename: Avi
authors.initials: A
authors.lastname: Khafif
authors.forename: Nevo
authors.initials: N
authors.lastname: Margalit
authors.forename: Aharon
authors.initials: A
authors.lastname: Amir
authors.forename: Eyal
authors.initials: E
authors.lastname: Gur
authors.forename: Dan M
authors.initials: DM
authors.lastname: Fliss