Clinical experience of neurosurgical reconstruction in anterior skull base lesions

Surgery of the anterior skull base confronts with the life-threatening risks of infection and cerebrospinal fluid (CSF) leakage, especially after extensive tumor resection. Avoidance of these complications demands a good intraoperative reconstruction. The technical feasibility has been demonstrated in previous reports. A judicious rationale of surgical principle is investigated in review of our patients and other series.

Fourteen cases underwent neurosurgical procedures involving the anterior skull base by the authors between June 1992 and January 1994. Five patients with trauma, 1 with inflammation, and 8 with space-occupying lesion were included. The modality of skull base reconstruction and patients' outcome were evaluated.

Eleven of these cases accepted reconstructive procedures to some extent including pericranium, lyodura, tissue glue, bone graft and muscle flaps. Four cases of traumatic CSF leakage were successfully repaired after anterior skull base reconstruction. One case with traumatic optic neuropathy restored vision after surgical optic nerve decompression. A rhinogenic infected discharging sinus was cured with pedicle island flap obliteration. Space-occupying lesions in 8 cases were totally removed without postoperative wound infection, CSF leakage, or meningitis, of which 2 cases of malignancy recurred 7 and 5 months after operation respectively. The follow-up period was from 5 to 26 months with a mean of 14 months.

Meticulous reconstruction with different possibilities of closure is the cornerstone of anterior skull base surgery, in spite of its difficulties and needs for extensive resection. Combined craniofacial resection could achieve "en bloc" or radical excision of "inoperable" anterior skull base lesions confidently with low morbidity and mortality based on skillful reconstructive techniques.