Available online 29 November 2012
Publication year: 2012
Source:World Neurosurgery
Objective To describe the effectiveness of local vascularized flaps for the repair of various skullbase defects. Methods Retrospective review of all head and neck surgical oncology cases done at a major tertiary care center between 2005 and 2008. A cohort of 138 patients undergoing skullbase surgery was analyzed Results 18 patients met our inclusion and exclusion criteria requiring local vascularized flap or free graft reconstruction. The mean age of our patients was 39.7 years with an equal distribution of males and females. The mean follow up was 16.4 months. Neoplastic causes accounted for the majority of skull base lesions (11/18 cases), followed by traumatic lesions (5/18 cases). Other causes of lesions in our study included encephalocele (1 cases), and infection (1 case). The most common location for skull base defects in our study was the anterior skull base (14/18 cases). Other locations included the infratemporal fossa (1 case). The mean size of defect that was repaired was 4.46cm and a mean area of 12.85 cm2. Repair with local vascularized tissue flaps resulted in a success rate of 87.5%. Moreover our meningitis and CSF leak rate was only 11.1% after repair. Conclusion Local vascularized flap utilization in open reconstruction of the skullbase has an excellent success rate with no second donor site morbidity. The success is comparable to free tissue transplant reconstruction and should be in the armamentarium of every neurosurgeon and skullbase surgeon. Appropriate incision planning and preoperative evaluation and selection is essential for the success of this type of reconstructive technique.
Júlio Leonardo B. Pereira
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