Reconstruction of the Base of Skull Defect—Lessons Learned over 25 Combined Years

Abstract

With an increased understanding of the pathological processes involved in perinerual spread, surgery has come to play a greater role in its management. As skull base techniques have been refined, the reconstructive surgeon has been presented with increasingly complex and voluminous defects requiring repair. To enable such surgery to have acceptable outcomes, attention to form and function is paramount. This article describes the methods of repair, which have evolved over the last 25 years of practice, and that we find to be both reliable and durable. Our accumulated experience is presented as a treatment algorithm, which will aid the skull base reconstructive surgeon to achieve success for the wide variety of defects encountered with these patients.

Keywords

skull base defect - perineural spread - skull base malignancy - free flap reconstruction - cerebrospinal fluid leak

Pearls of Wisdom

 • Careful three-dimensional thinking and planning to ensure flap will fit the defect and obliterate all spaces.

 • Choose a reliable, well-vascularized flap that you know well.

 • Meticulous attention to detail of the inset and focus on key defects. There is only one good chance at inset to the bony skull base.

 • If you can see CSF, seal it and drain the space.

 • Begin with the end in mind. Careful planning to avoid complications.

 • Work with like-minded head and neck surgeons and neurosurgeons. Their attention to detail is as important as that of the reconstructive surgeon.

• References

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