Reconstructive Aspects in Anterior Skull Base Malignancies

Introduction: The treatment of malignancies of the anterior skull base is a coordinated multispeciality approach that combines neurosurgery, otorhinolaryngology, and oral and maxillofacial surgery. The reconstruction of the defects caused by tumor resection focuses on the separation of the intracranial contents from the facial bones and the re-establishment of an unobtrusive facial appearance. For an effective reconstruction, regional and microvascular soft tissue flaps, grafting with autogenous bone, and resorbable osteosynthesis plates play a major role.

Material and Methods: Anterior skull base tumors are managed using intracranial, extracranial, or combined approaches. To achieve access to the tumor, sometimes a LeFort I osteotomy is required. For the reconstruction of bony defects of the skull base, calvarial split bone grafts are used frequently. The fixation of the grafts can be carried out with resorbable plates in order to avoid the necessity of removal at a later point of time. For larger defects that may combine skull base defects and defects of bone and soft tissue of the face, the reconstructive options include myocutaneous and osteomyocutaneous microvascular flaps harvested from the forearm, upper arm, fibula, or scapula.

Results: Different reconstruction techniques help to safely avoid cerebral spinal fluid leakage. The variety of techniques used for structural reconstruction of skull base and adjacent defects can be applied with a minimal complication rate in patients. Intracranial abscess or osteomyelitis have not been encountered. Loss of bone grafts or complete necrosis of soft tissue flaps have not been observed.

Conclusions: Although sophisticated reconstruction techniques are applied after the resection of anterior skull base malignancies, postoperative complications only occur in a minimal number of patients. Even the frequent application of postoperative irradiation did not seem to affect the graft survival. The different reconstruction techniques can be considered to be well established. The use of resorbable plates helps to reduce the number of secondary surgeries for plate removal.