Skull Base Reconstruction

Skull Base Reconstruction
Ebrahim karimi, Hadi Samimi, Masoud Motasaddi Zarandy, Ali Kouhi, Pedram Borghei
Otorinolaryngology reaserch center, Amir Alam Hospital, Tehran university of medical
sciences, Tehran, Iran

PURPOSE: Reconstruction of skull base defects following tumor resection is of paramount importance in avoiding serious and life-threatening complications. Thus, a successful outcome following skull base tumor ablation often depends as much on the reconstruction as it does on the resection. we want to present our new Experince in Recostraction of Extensive Oncologic defects of skull base.

METHODS: Subjects included 15 patients undergoing skull base reconstruction from 2013 to 2016. Reconstructive outcomes, including flap survival, CSF leak, and ICU and Hospitai stay, were analyzed.

RESULTS: Reconstructions included 10 local or regional pedicled flaps and 5 microvascular free flaps. Free flaps were usually selected over pedicled flaps for patients with a history of prior radiation, and extensive defect. Skull base reconstructions were performed for 4 Region I (anterior) defects, 2 Region II (middle) defects, 4 Region III (posterior or lateral) defects, and 5 defects that involved Regions II+III. Pedicled flaps were used most frequently in Region III (76% of pedicled flaps). The most common pedicled flap which was used include: the supraclavicular artery island flap (SCAIF). The most common free flaps which were used include: the anterolateral thigh and rectus abdominis myocutaneous free flaps.
There were no significant differences in the rate of overall complications between patients reconstructed with a pedicle flap and patients reconstructed with a free flap. There was one case of CSF leakage with spontaneous recovery in cases of pedicle flap reconstruction. The total operative time was shorter for cases involving reconstruction with regional flaps compared to free flaps (6.5 hours vs. 11.5 hours, p<0.0001), as were intensive care unit (ICU) and hospital stays (2 days vs. 4 days, p<0.0001, and 7 days vs. 12 days, p<0.0001, respectively). The mean follow-up time was 28 months.

CONCLUSION: The creation of a functional separation of the intracranial and extracranial cavities can be extremely difficult to accomplish, especially when multiple cavities (nasal, oral, pharyngeal) are violated. we recommend using regional flaps for small defects based on minimal donor site morbidity, and shorter operative times, ICU, and hospital stays, particularly in Region III. For extensive defects, and in cases involving prior surgery, radiation, or chemotherapy, free flaps are preferred. The anterolateral thigh and rectus abdominis myocutaneous free flaps were useful for large defects, especially those involving multiple regions and when multiple skin paddles were required.