Reconstruction after open surgery for skull-base malignancies
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TOPIC REVIEW
Reconstruction after open surgery for skull‑base malignancies Matthew M. Hanasono1 Received: 6 October 2019 / Accepted: 11 December 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Resection of skull base malignancies that would have been associated with unacceptable morbidity and mortality in the past are now performed with reliable results due in large part to advancements in reconstructive surgery. The goal of this review is to describe the best evidence-based methods of reconstruction following open surgery for skull base tumors in order to attain improved outcomes for patients. Methods A review of recent studies involving reconstruction following open skull base surgeries was performed. Results Free flaps are now the most commonly recommended method for reconstruction following open skull base surgery, although pedicled regional flaps such as the temporalis muscle, supraclavicular, and submental flaps may be good alternatives in specific cases. Recent series suggest high reconstructive free flap survival rates and low levels of recipient site complications, including neurosurgical complications such as cerebrospinal fluid leak. The location of the resection defect predicts the reconstructive challenges and guides pedicled and free flap selection. Conclusion Refinements in flap selection and reconstructive technique continue to improve patient outcomes and decrease complication rates following open surgery for skull base malignancies. Keywords Skull base reconstruction · Skull base surgery · Free flap · Temporalis muscle flap · Supraclavicular flap · Anterolateral thigh free flap
Introduction Oncologic defects involving the skull base are especially challenging to treat because of the risk for major, potentially life-threatening, complications that may occur should the reconstruction fail, such as dural exposure, cerebrospinal fluid (CSF) leak, pneumocephalus, and meningitis. Reconstructive techniques that minimize the risks for such complications as well as restore appearance and function have become a critical part of most open skull base surgeries. Improved reconstructive methods not only improve the safety of surgery, but can increase the efficacy of skull base tumor treatment by allowing more complete resection with wide margins. Local pedicled flaps are primarily used for reconstruction of dural exposure following endoscopic and craniotomy approaches. For example, the posterior nasoseptal * Matthew M. Hanasono [email protected] 1
flap, based on the posterior nasoseptal artery, is a workhorse for reconstructing defects arising from endoscopic resections [1]. Pericranial and temporoparietal fascia flaps are commonly used for reinforcing dural repairs resulting from intracranial resections [2, 3]. Based on data demonstrating high complication rates, most regional pedicled flaps such as the pectoralis major, trapezius, and latissimus dorsi muscle and myocutaneous flaps are now infrequently used, although they may still be necessary in
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