title: [Anterior skull base defects - algorithm for reconstruction].
abstract: BACKGROUND
  After tumor surgery or traumatic defects the anterior skull base needs sufficient closure in order to prevent rhinoliquorrhea, ascending infection and brain tissue prolaps. Small defects are sufficiently closed by non-vital tissue, e. g. mucosa, muscle, fat, fascia, bone, allogenic, xenogenic or alloplastic material. Larger defects of the skull base often require more extensive surgery, including transfer of local or distal vascularized flaps. The current article presents a stepwise tutorial for reconstruction of the skull base and by a large case series focuses on the interdisciplinary therapy of complex (size, recurrence, after radiotherapy) skull base defects.
  
  
  METHODS
  Complex defects with small diameter, which can occur after extended sinus surgery, were permanently closed by local mucosa flaps of the lower turbinate or of the septum (n=31). Larger defects, e. g. after combined transcranial and endonasal tumor surgery, were closed by a 'sandwich technique' containing a galea periost flap and a calvarian split transfer (n=10). Reconstruction of the dura with fascia lata and local transfer of the temporal muscle were efficient for frontobasal defects with a more lateral location (n=4). Transfer of a distal desepithelialised vascularized forearm flap represents the ultimate procedure for reconstruction of large skull base defects, which was performed in 4 of our patients.
  
  
  CONCLUSIONS
  Successive escalation of the therapy and integra-tion of the entire repertoire of plastic-reconstructive surgery allows for durable closure of complex skull base defects. In every case, close cooperation between ENT- and neurosurgeons is necessary for planning and performance of a successful surgical procedure.
authors.affiliation: Universitätsklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm.
authors.forename: T K
authors.initials: TK
authors.lastname: Hoffmann
authors.affiliation: Universitätsklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm.
authors.forename: M
authors.initials: M
authors.lastname: Scheithauer
authors.affiliation: Universitätsklinik für Neurochirurgie, Universitätsklinikum Ulm.
authors.forename: R
authors.initials: R
authors.lastname: Koenig
authors.affiliation: Universitätsklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm.
authors.forename: P J
authors.initials: PJ
authors.lastname: Schuler
mesh_terms: D000328:Adult; D000465:Algorithms; D002559:Cerebrospinal Fluid Rhinorrhea / Q000517:prevention & control; D003299:Cooperative Behavior; D035262:Cranial Fossa, Anterior / Q000601:surgery*; D004677:Encephalocele / Q000517:prevention & control; D004724:Endoscopy / Q000379:methods; D006801:Humans; D033183:Interdisciplinary Communication; D008866:Microsurgery / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D011391:Prolapse; D019651:Plastic Surgery Procedures / Q000379:methods*; D012225:Rhinoplasty / Q000379:methods; D013524:Surgical Flaps / Q000098:blood supply / Q000601:surgery; D013530:Surgical Wound Infection / Q000517:prevention & control