title: Intracranial free tissue transfer for massive cerebrospinal fluid leaks of the anterior cranial fossa.
abstract: OBJECTIVE
  The management of large skull base defects with refractory cerebrospinal fluid (CSF) leaks treated with intracranially placed free tissue transfers was examined.
  
  
  METHODS
  A retrospective review of all cases of CSF leak presenting to the senior author from 1997 to 2008 in a private tertiary care referral practice was performed. Patients with intracranially placed free flaps were specifically examined for this review.
  
  
  RESULTS
  In total 109 patients with skull base defects larger than 4 cm(2) or intractable CSF leaks were identified. Eighty-eight patients underwent reconstruction with local tissue flaps or free tissue grafts. Persistent massive leaks were repaired with 11 intracranial free tissue transfers. CSF fistulas were successfully closed in each instance, with no cases of flap failure or major complications.
  
  
  CONCLUSIONS
  Intracranial placement of nonskin-bearing free tissue is an excellent treatment alternative for massive CSF leaks and refractory CSF fistulas related to large skull base defects.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, the University Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Jared
authors.initials: J
authors.lastname: Inman
authors.forename: Yadranko
authors.initials: Y
authors.lastname: Ducic
mesh_terms: D001847:Bone Diseases / Q000601:surgery; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000601:surgery*; D035262:Cranial Fossa, Anterior / Q000293:injuries / Q000601:surgery*; D005205:Fascia / Q000637:transplantation; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012887:Skull Fractures / Q000601:surgery; D014680:Veins / Q000637:transplantation; D014948:Wounds, Gunshot / Q000601:surgery