Reconstruction of Anterior Skull Base Defects

Introduction: Successful reconstruction after cranial base surgery is essential to prevent potentially life-threatening complications. Goals of reconstructive procedures are to repair anatomical interface between intracranial and extracranial spaces, and to correct functional and aesthetic deformity. Autologous and heterologous materials are available, and multiple factors may influence the surgical choice. We describe our experience at Ospedale Riuniti di Bergamo and discuss advantages and limits of reconstructive techniques.

Patients: From January 2005 to October 2011, 235 patients underwent skull base surgery. Of these, 112 patients (62 females, 50 males; mean age, 56) had lesions involving the anterior skull base (74% meningiomas, 18% adenomas, 8% miscellaneous).

Results and Discussion: Pericranial flap was the first choice to restore separation of the cranial cavity from the upper aerodigestive tract. When the pericranial flap was not available, temporalis muscle and fascia were used for anterior-middle fossa reconstruction and orbitotomy. However, the “temporalis muscle and fascia's technique” was limited by the flap's mobility and donor site deformity. In case of a large skull defect or during transsphenoidal surgery, a bone graft (± fascia lata) was used to support intracranial structures. Free vascularized flaps were performed in patients with sacrificed dura mater and/or facial skin. Heterologous materials were used when autologous material was not available because of tumoral infiltration, tissue retraction, or post-radiotherapy treatment. A new bioinductive equine collagen-derived product (TissuDura) was used to restore dural defects.

Conclusions: With proper selection of patients, cranial base reconstruction can be achieved. When possible, defects should be repaired with autologous and well-vascularized tissues to promote fast and complete healing.