[Development of reconstruction techniques of the anterior skull base after tumor excision]

183 benign and malignant tumors of the anterior cranial base were operated in the department of neurosurgery at Ste Anne's hospital, from June 1982 to December 1993. The bone defect was repaired first with bone sheets taken from the inner table of the cranial flap. Then allografts of irradiated bone and madreporic coral blocks were used as reconstruction material. Since January 1992, no bone reconstruction was performed; the anterior base was just covered with a sheet of Vicryl Composit Mesh (VCM) which was secured bilateraly on the pterion, the temporalis pars squamosa and around the ethmoid defect. This sheet of VCM reinforces the dural plane, which is always lined with a pediculated galea flap. These technical changes and evolution were motivated by: i/- a desire to simplify the surgical technique: ii/- the risk of transmission of viral diseases such as Creutzfeld Jacob disease by allografts, iii/- the frequency of splits and/or falls of madreporic coral grafts. Whatever the material, the infection risks were identical: 8% of subcutaneous and/or deep suppurations, 5% of post-operative meningitis. One patient presented with a transient clinical rhinorrhea.