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Microvascular reconstruction of the skull base: indications and procedures
H Schliephake1, R Schmelzeisen, M Samii
1Department of Oral and Maxillofacial Surgery, Hannover Medical School, Medizinische Hochschule Hannover, Germany.
Purpose:
The aim of the current study was to review the use of free tissue transfer for reconstruction of the skull base and for coverage of intracranial contents.
Patients And Methods:
From 1990 until 1996, revascularized flaps were transferred to the skull and the skull base in 11 patients in whom intracranial/extracranial resection of tumors of the skull base was performed in cooperation with the Department of Neurosurgery. The defects resulted from removal of squamous cell carcinomas (n = 4), basal cell carcinomas (n = 4), malignant melanoma, malignant schwannoma, and malignant meningioma. Defect repair was accomplished by revascularized transfer of latissimus dorsi muscle flaps in seven cases and rectus abdominis flaps and forearm flaps in two cases each. In five patients with extensive intracranial tumor spread, reconstruction was performed for palliative reasons.
Results:
A safe soft tissue closure of the intracranial and intradural space was achieved in all patients, whereas the contour of the facial skull and the neurocranium was satisfactorily restored at the same time. By using the entire length of the grafted muscle, the vascular pedicle could be positioned next to the external carotid artery and conveniently connected to the cervical vessels. The mean survival time of the patients with palliative treatment was 8.4 months, with an average duration of hospital stay of 24.5 days.
Conclusions:
Despite the increased surgical effort of revascularized tissue transfer, microvascular reconstruction of large skull base defects appears to be justified, even as a palliative measure.