Local vascularized flap reconstruction of the skull base—clinical outcomes and analysis

The purpose of this study was to describe the effectiveness of local vascularized flaps for the repair of various skull base defects.

We analyzed a cohort of 138 patients undergoing skull base surgery in a retrospective review of all head and neck surgical oncology cases done at a major tertiary care center between 2005 and 2008.

Eighteen patients met our inclusion criteria, requiring local vascularized flap or free graft reconstruction. The mean age of our patients was 39.7 years, with an equal distribution of men and women. 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 case), 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 repaired was 4.46 cm, and the mean area was 12.85 cm(2). Repair with local vascularized tissue flaps resulted in a success rate of 87.5%. Moreover, our meningitis and cerebrospinal fluid leak rate was only 11.1% after repair.

Local vascularized flap utilization in open reconstruction of the skull base 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 skull base surgeon. Appropriate incision planning and preoperative evaluation and selection is essential for the success of this type of reconstructive technique.