Article
An algorithm for microvascular frontal skullbase reconstruction
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Authors
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K.G. Krishnan
- Department of Neurosurgery, Hannover Medical School
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A. Müller
- Department of Neurosurgery, Krankenhaus Barmherzige Brüder Regensburg
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V. Seifert
- Department of Neurosurgery, Johann Wolfgang Goethe University, Frankfurt
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J.K. Krauss
- Department of Neurosurgery, Hannover Medical School
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G. Schackert
- Department of Neurosurgery, Carl Gustav Carus University, Dresden
| Published: | April 28, 2011 |
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Outline
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Objective: The use of vascularized flaps in the treatment of non-healing wounds is well-known. Certain neurosurgical nosoligies could be viewed as ‘internal' wound healing problems. Recurrent CSF-rhinorrhea due to frontobasal disintegrity is one of those unyielding ‘internal' wound-healing problems. Bringing vascularized tissue to this non-healing wound bed is a possible solution for the treatment of such difficult cases. The closure of morphological frontobasal disintegrity may be treated by local, regional and free microvascular tissue. Our objective is to present a series of neurosurgical cases where microvascular tissue transfer found successful application.
Methods: Among 84 patients undergoing frontal skullbase reconstruction, we treated 6 patients with recurrent frontobasal CSF leakage using the free microvascular tissue transfer technique. All these patients were operated several times using conventional methods. In two of the six patients the recurrent intractable frontobasal disintegrity was a result of cranio-cerebral trauma (gunshot wound and automobile accident). One patient incurred this problem after initial decompression of the optic nerve due to Cruzon's craniosynostosis. In the rest the cause was invasive skullbase tumors. In all patients the bilateral subfrontal, intradural approach to the anterior skullbase was employed. In the first two patients free- microvascular latissimus dorsi muscle flap and omentum were used for lining the frontal base. In the other patients we used a free vascularized fascia-lata muscle. The choice of the flap was based on the form and extent of the defects.
Results: None of the cases developed further recurrences of frontal skullbase disintegrity or CSF leaks during a follow-up of 12 months or more when appropriate.
Conclusions: Vascularized tissue has better and longer-lasting mechanical properties and is more resistant to bacterial invasion in comparison to their non-vascularized analogs. In neurosurgical practice one may keep the option of free vascularized tissue transfer open in difficult unyielding ‘internal' wound healing problems as described here. An algorithm of surgical frontal base reconstruction was evolved.
