gms | German Medical Science

Objective: Lesions of the anterior skull base require sufficient closure in order to prevent cerebrospinal fluid (CSF) leak, ascending infection and/or brain tissue prolapse. The transfer of devitalized autologous, allogenic or even xenogeneic material bears problems, particularly in larger defects or in a recurrent situation. This study was undertaken to evaluate our surgical strategy using exclusively autologous vascularized tissue for reconstruction of the anterior skull base.

Method: The anterior skull base with various complex defects of 25 patients was reconstructed in an interdisciplinary setting by vascularized, autologous tissue transfer. Minor defects (<2.5 cm in max. diameter), generally occurring after extended endoscopic skull base approaches (n=14, among those meningiomas, recurrent CSF fistulas, chordoma, chondroblastoma, metastasis, nasal fistula), were reconstructed by a local, vascularized pedicled mucosal flap of the lower turbinate (n=1) or septum (n=13). Patients with major defects (>2.5 cm in max. diameter, n=11), comprising those with malignoma, meningoencephalocele, aneurysmatic bone cyst and trauma, were repaired by a „sandwich technique“ with a combination of calvarian split and galea periosteum flap in 10 patients and in one case with a temporalis muscle flap.

Results: After a mean follow-up time of 17.5 months 22 of the 25 cases were successfully repaired with respect to prevention and treatment of CSF leakage or brain tissue prolapse, only 3 cases needed surgical revision.

Conclusions: The reconstruction of the anterior skull base bearing complex lesions is feasible by using vascularized, autologous local tissue transfer in a close interdisciplinary cooperation.