Proposal for a Long-Term Study of the Reconstructive Options for Repairing Surgical Defects in the Anterior Skull Base

There are multiple different methods for reconstructing the anterior skull base following resection. Controversy still exists as to the best approach that minimizes complications. The literature is testament to this with many papers detailing various options from different institutions. The variety of pathologies and surgical approaches to the anterior cranial base is reflected by the many variations in practice. The defect in the anterior skull base, however, is a relatively independent and predictable entity. However, to date there has been no clear prospective comparison of the different reconstructive options within an institution, although algorithms have been proposed.

Local and distant grafts, including fascia lata, split skin grafts, and nasal mucosal grafts, are widely employed. Pedicled nasal mucosal flaps are commonly used, and more focus on these in recent years has come from the increasingly popular endoscopic approaches. Free tissue pedicled flaps have been described. Pericranial and temporalis flaps are the more traditional reconstructive options for the anterior cranial base procedures. Lastly, allograft material and synthetic products have been used. These all have their pros and cons, which vary between cases.

At the beginning of my consultant career, I have reviewed the literature and proposed a prospective study comparing the different reconstructive techniques for repairing the anterior skull base. I plan to run this study over the next 25 years of my practice to develop clear guidance based on this experience. To achieve this, I propose a standard data set for both this study and general anterior skull base clinical practice.