Fish Skin to Reconstruct Orbit following Resection of Anterior Skull Base Tumor

Orbital involvement is common in the resection of the anterior skull base tumor removal and frequently requires resection of one or more of the orbital walls. There are many reconstructive options, such as autologous graft and alloplastic materials; however, some disadvantages include donor site morbidity, increased risk of infection, biocompatibility, and long-term stability. An interesting and novel option for orbital reconstruction materials is the intact fish skin xenograft (FSG). Derived from wild Atlantic cod, the FSG is a biologically active, acellular dermal matrix previously utilized in treating burn wounds, necrotizing fasciitis, and skin regeneration. It boasts high biocompatibility, resistance to infection, and rapid integration with patient tissue, which makes it an ideal option for orbital reconstruction. We describe a case of using the FSG in orbital reconstruction following surgical resection of an anterior skull base tumor that extended into the left orbit.

The patient is a 62-year-old woman found to have a large (7 cm × 4.5 cm × 7 cm), left-sided, extra-axial mass lesion arising from the cribriform plate and olfactory groove with extension to frontal, ethmoid, left sphenoid sinus, and left orbit. On initial ophthalmic evaluation, the patient was found to have significant proptosis and a −3 vertical gaze deficit of the left eye. After discussion at our institution’s multidisciplinary tumor board, a decision was made for upfront surgical resection with neurosurgery (NES), otolaryngology (ORL), and ophthalmology.

Following surgical resection by the NES and ORL teams, the majority of the tumor was removed; the anterior orbital roof, medial wall, and orbital floor up to the infraorbital nerve anteriorly and to the infraorbital fissure posteriorly were dissected away, leaving only a small amount of the bony apex. As the sinus cavities were involved, the orbital strut was also removed. Further soft tissue dissection was performed to remove abnormal periosteum until normal periorbital fat was encountered. At this point, intraoperatively, the globe was enophthalmic, nasally deviated, and esotropic position. The reconstruction consisted of using the split-thickness graft of the inner table of the calvarial window sculpted via ultrasonic aspirating bone scalpel to serve as the orbital roof. A double-layer FSG was fashioned and anchored with a suture to the nasal edge of the bone graft. The FSG was then wrapped around the medial orbital wall, and it was tucked to pressure-place the FSG along the remnant anterior orbital floor and adjusted until the globe was in a slightly proptotic position with normal alignment grossly. The skull base defects were closed with a pericranial flap, and the nose was packed with a bioresorbable nasal dressing.

Thus far in the early postoperative period, the patient has been doing well, with resolved motility deficits and a major reduction in proptosis ([Fig. 1] and [2]).

Fig. 1 (A) Preoperative coronal magnetic resonance imaging (MRI) fat-suppressed (FS). (B) Postoperative coronal T1 MRI FS.

Fig. 2 (A) Preoperative axial T1 MRI. (B) Postoperative axial T1 MRI.

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Artikel online veröffentlicht:
07. Februar 2025