Single Layer Repair of Large Anterior Skull Base Defects without Vascularized Mucosal Flap.
ObjectivesBilateral anterior skull base (ASB) defects following endoscopic endonasal tumor resection are most commonly repaired utilizing multilayered reconstruction with a vascularized mucosal flap. Single-layer closure of large ASB defects has been described in the literature but this technique has yet to gain a widespread use. We report our experience with a series of patients who underwent reconstruction of large ASB defects using a single-layer intradural graft, without nasoseptal flaps. We also compared the use of acellular dermal matrix (AlloDerm, LifeCell, Branchburg, New Jersey, United States) or collagen matrix xenograft (Duramatrix, Stryker, Kalamazoo, Michigan, United States) as the graft biomaterial.DesignA retrospective case series.SettingTertiary academic medical center.Main Outcome MeasuresPostoperative cerebrospinal fluid leak, the number of postoperative debridements, the number of postoperative infections, and time to remucosalization.ResultsTwo patients were reconstructed with AlloDerm and three with Duramatrix, with all patients receiving postoperative external beam radiation. There were no postoperative cerebrospinal fluid leaks identified in these patients during follow-up. The AlloDerm group showed increased postsurgical crusting, the number of clinically apparent postoperative infections, and an increased time to remucosalization.ConclusionsSingle-layer repair without a vascularized mucosal flap is a viable method of skull base repair for large ASB defects. We found repair with Duramatrix was superior, with less graft crusting and infection, requiring fewer debridements.
Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States.
Frederick
F
Yoo
Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States.
Marilene B
MB
Wang
Department of Neurosurgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States.
Marvin
M
Bergsneider
Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States.
Jeffrey D
JD
Suh
anterior cranial fossa; biocompatible materials; paranasal sinus neoplasms; reconstructive surgical procedures; skull base; skull base neoplasm