Upfront Anterolateral Thigh Free Flap Reconstruction after Posterior Fossa Skull Base Tumor Resection

Introduction: Posterior fossa reconstruction following skull base tumor resection remains a complex surgical procedure characterized by relatively high rates of postoperative complications, including cerebrospinal fluid (CSF) leakage. Upfront anterolateral thigh (ALT) free flap reconstruction of the posterior fossa is a technique that has shown promise in reducing postoperative complication rates. However, with upfront ALT free flap use in this context, surgical outcomes and the relationships between various patient characteristics, perioperative variables, and surgical outcomes remain poorly investigated.

Objective: We assess postoperative outcomes following the use of upfront ALT free flap reconstruction of the posterior fossa and compare various perioperative variables to examine their possible relationships with surgical outcomes for further study.

Methods: A retrospective review of 6 patients deemed high risk for wound healing complications who underwent upfront ALT free flap reconstruction following posterior fossa skull base tumor resection at our institution between 2018 and 2024 was performed. Data was collected on patient demographics (age, BMI, smoking history), comorbidities (diabetes, coronary artery disease [CAD], chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), prior radiation therapy), and surgical details (indication for surgery, history of posterior fossa surgery, artery/vein used for anastomosis, length of surgery, history of prior free flap reconstruction). Data collected on outcome variables includes length of postoperative hospital/ICU stay, postoperative CSF leak, pneumocephalus, and seizures. Regression analysis was performed but remains inherently flawed due to the small number of patients in the case series. A correlation coefficient was calculated for each predictor–outcome variable pair. The Bonferroni correction was applied to the resulting p-values. Variables with a frequency of 0 among the six patients, such as the presence of diabetes, CKD, CAD, and postoperative CSF leakage, were excluded from our analysis.

Results: The study included 6 patients with a mean age of 44 years (range: 23–53), with skull base tumor resection as the indication for surgery in all cases (2 squamous cell carcinomas involving the temporal bone, a middle fossa meningioma, a petroclival meningioma, a cochlear schwannoma, and a vestibular schwannoma). The average length of surgery was 11.88 hours (range: 10.37–14.58). Postoperatively, two patients developed pneumocephalus, and one developed seizures. None of the patients developed a CSF leak or other complications related to the ALT-free flap repair. Two patients had received prior radiation therapy, which was found to strongly correlate with increased postoperative ICU stay at a statistically significant level (r = 0.975, p = 0.0371). No other relationship achieved statistical significance.

Conclusion: The lack of CSF leakage and other postoperative complications relating to the free flap repair in the six included patients aligns with data suggesting that upfront ALT free flap repair for posterior fossa reconstruction could be associated with improved surgical outcomes without an unduly increased length of surgery. Additionally, the potential association between prior radiotherapy and increased postsurgery ICU stay represents a topic for further investigation.

 

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Artikel online veröffentlicht:
07. Februar 2025