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Semin Plast Surg 2017; 31(04): 189-196
DOI: 10.1055/s-0037-1607273
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Open Anterior Skull Base Reconstruction: A Contemporary Review

Daniel Kwon
1   Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California
,
Alfred Iloreta
2   Division of Rhinology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
,
Brett Miles
3   Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
,
Jared Inman
1   Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California
› Author Affiliations
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Publication History

Publication Date:
25 October 2017 (online)

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Abstract

Skull base extirpative and reconstructive surgery has undergone significant changes due to technological and operative advances. While endoscopic resection and reconstruction will continue to advance skull base surgery for the foreseeable future, traditional open surgical approaches and reconstructive techniques are still contemporarily employed as best practices in certain tumors or patient-specific anatomical cases. Skull base surgeons should strive to maintain a working knowledge and technical skill set to manage these challenging cases where endoscopic techniques have previously failed, are insufficient from anatomical constraints, or tumor biology with margin control supersedes the more minimally invasive approach. This review focuses on the reconstructive techniques available to the open skull base surgeon as an adjunct to the endoscopic reconstructive options. Anatomic considerations, factors relating to the defect or patient, reconstructive options of nonvascular grafts, local and regional flaps, and free tissue transfer are outlined using the literature and author's experience. Future directions in virtual surgical planning and emerging technologies will continue to enhance open and endoscopic skull base surgeon's preparation, performance, and outcomes in this continually developing interdisciplinary field.

Keywords

skull base surgery - cranial base surgery - skull base reconstruction - anterior skull base - open skull base
 

  • References

  • 1 Ketcham AS, Hoye RC, Van Buren JM, Johnson RH, Smith RR. Complications of intracranial facial resection for tumors of the paranasal sinuses. Am J Surg 1966; 112 (04) 591-596
    CrossrefPubMedGoogle Scholar
  • 2 Ganly I, Patel SG, Singh B. , et al. Complications of craniofacial resection for malignant tumors of the skull base: report of an international collaborative study. Head Neck 2005; 27 (06) 445-451
    CrossrefPubMedGoogle Scholar
  • 3 Weber SM, Kim JH, Wax MK. Role of free tissue transfer in skull base reconstruction. Otolaryngol Head Neck Surg 2007; 136 (06) 914-919
    CrossrefPubMedGoogle Scholar
  • 4 Irish JC, Gullane PJ, Gentili F. , et al. Tumors of the skull base: outcome and survival analysis of 77 cases. Head Neck 1994; 16 (01) 3-10
    CrossrefPubMedGoogle Scholar
  • 5 Urken ML, Catalano PJ, Sen C, Post K, Futran N, Biller HF. Free tissue transfer for skull base reconstruction analysis of complications and a classification scheme for defining skull base defects. Arch Otolaryngol Head Neck Surg 1993; 119 (12) 1318-1325
    CrossrefPubMedGoogle Scholar
  • 6 Yano T, Okazaki M, Tanaka K. , et al. A new concept for classifying skull base defects for reconstructive surgery. J Neurol Surg B Skull Base 2012; 73 (02) 125-131
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Zanation AM, Carrau RL, Snyderman CH. , et al. Nasoseptal flap reconstruction of high flow intraoperative cerebral spinal fluid leaks during endoscopic skull base surgery. Am J Rhinol Allergy 2009; 23 (05) 518-521
    CrossrefPubMedGoogle Scholar
  • 8 Patel MR, Stadler ME, Snyderman CH. , et al. How to choose? Endoscopic skull base reconstructive options and limitations. Skull Base 2010; 20 (06) 397-404
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Harvey RJ, Nogueira Jr JF, Schlosser RJ, Patel SJ, Vellutini E, Stamm AC. Closure of large skull base defects after endoscopic transnasal craniotomy. Clinical article. J Neurosurg 2009; 111 (02) 371-379
    CrossrefPubMedGoogle Scholar
  • 10 Thorp BD, Sreenath SB, Ebert CS, Zanation AM. Endoscopic skull base reconstruction: a review and clinical case series of 152 vascularized flaps used for surgical skull base defects in the setting of intraoperative cerebrospinal fluid leak. Neurosurg Focus 2014; 37 (04) E4
    CrossrefPubMedGoogle Scholar
  • 11 Soudry E, Turner JH, Nayak JV, Hwang PH. Endoscopic reconstruction of surgically created skull base defects: a systematic review. Otolaryngol Head Neck Surg 2014; 150 (05) 730-738
    CrossrefPubMedGoogle Scholar
  • 12 Germani RM, Vivero R, Herzallah IR, Casiano RR. Endoscopic reconstruction of large anterior skull base defects using acellular dermal allograft. Am J Rhinol 2007; 21 (05) 615-618
    CrossrefPubMedGoogle Scholar
  • 13 Harvey RJ, Smith JE, Wise SK, Patel SJ, Frankel BM, Schlosser RJ. Intracranial complications before and after endoscopic skull base reconstruction. Am J Rhinol 2008; 22 (05) 516-521
    CrossrefPubMedGoogle Scholar
  • 14 Paderno A, Piazza C, Bresciani L, Vella R, Nicolai P. Microvascular head and neck reconstruction after (chemo)radiation: facts and prejudices. Curr Opin Otolaryngol Head Neck Surg 2016; 24 (02) 83-90
    CrossrefPubMedGoogle Scholar
  • 15 Wormald PJ, McDonogh M. The bath-plug closure of anterior skull base cerebrospinal fluid leaks. Am J Rhinol 2003; 17 (05) 299-305
    PubMedGoogle Scholar
  • 16 Leng LZ, Brown S, Anand VK, Schwartz TH. “Gasket-seal” watertight closure in minimal-access endoscopic cranial base surgery. Neurosurgery 2008; 62 (05) (Suppl. 02) ONSE342-343 ; discussion ONSE343
    PubMedGoogle Scholar
  • 17 Wigand ME. Transnasal ethmoidectomy under endoscopical control. Rhinology 1981; 19 (01) 7-15
    PubMedGoogle Scholar
  • 18 Narotam PK, van Dellen JR, Bhoola KD. A clinicopathological study of collagen sponge as a dural graft in neurosurgery. J Neurosurg 1995; 82 (03) 406-412
    CrossrefPubMedGoogle Scholar
  • 19 Cappabianca P, Esposito F, Cavallo LM. , et al. Use of equine collagen foil as dura mater substitute in endoscopic endonasal transsphenoidal surgery. Surg Neurol 2006; 65 (02) 144-148 ; discussion 149
    CrossrefPubMedGoogle Scholar
  • 20 Verret DJ, Ducic Y, Oxford L, Smith J. Hydroxyapatite cement in craniofacial reconstruction. Otolaryngol Head Neck Surg 2005; 133 (06) 897-899
    CrossrefPubMedGoogle Scholar
  • 21 Garcia-Navarro V, Anand VK, Schwartz TH. Gasket seal closure for extended endonasal endoscopic skull base surgery: efficacy in a large case series. World Neurosurg 2013; 80 (05) 563-568
    CrossrefPubMedGoogle Scholar
  • 22 Hadad G, Bassagasteguy L, Carrau RL. , et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006; 116 (10) 1882-1886
    CrossrefPubMedGoogle Scholar
  • 23 Miles B, Davis S, Crandall C, Ellis III E. Laser-Doppler examination of the blood supply in pericranial flaps. J Oral Maxillofac Surg 2010; 68 (08) 1740-1745
    CrossrefPubMedGoogle Scholar
  • 24 Zanation AM, Snyderman CH, Carrau RL, Kassam AB, Gardner PA, Prevedello DM. Minimally invasive endoscopic pericranial flap: a new method for endonasal skull base reconstruction. Laryngoscope 2009; 119 (01) 13-18
    CrossrefPubMedGoogle Scholar
  • 25 Snyderman CH, Janecka IP, Sekhar LN, Sen CN, Eibling DE. Anterior cranial base reconstruction: role of galeal and pericranial flaps. Laryngoscope 1990; 100 (06) 607-614
    CrossrefPubMedGoogle Scholar
  • 26 Kantrowitz AB, Hall C, Moser F, Spallone A, Feghali JG. Split-calvaria osteoplastic rotational flap for anterior fossa floor repair after tumor excision. Technical note. J Neurosurg 1993; 79 (05) 782-786
    CrossrefPubMedGoogle Scholar
  • 27 Fortes FS, Carrau RL, Snyderman CH. , et al. Transpterygoid transposition of a temporoparietal fascia flap: a new method for skull base reconstruction after endoscopic expanded endonasal approaches. Laryngoscope 2007; 117 (06) 970-976
    CrossrefPubMedGoogle Scholar
  • 28 Chan JK, Harry L, Williams G, Nanchahal J. Soft-tissue reconstruction of open fractures of the lower limb: muscle versus fasciocutaneous flaps. Plast Reconstr Surg 2012; 130 (02) 284e-295e
    CrossrefPubMedGoogle Scholar
  • 29 Bakamjian VY, Souther SG. Use of temporal muscle flap for reconstruction after orbito-maxillary resections for cancer. Plast Reconstr Surg 1975; 56 (02) 171-177
    CrossrefPubMedGoogle Scholar
  • 30 Smith JE, Ducic Y, Adelson RT. Temporalis muscle flap for reconstruction of skull base defects. Head Neck 2010; 32 (02) 199-203
    PubMedGoogle Scholar
  • 31 Neligan PC, Mulholland S, Irish J. , et al. Flap selection in cranial base reconstruction. Plast Reconstr Surg 1996; 98 (07) 1159-1166 ; discussion 1167–1168
    CrossrefPubMedGoogle Scholar
  • 32 Moyer JS, Chepeha DB, Teknos TN. Contemporary skull base reconstruction. Curr Opin Otolaryngol Head Neck Surg 2004; 12 (04) 294-299
    CrossrefPubMedGoogle Scholar
  • 33 Chang DW, Langstein HN, Gupta A. , et al. Reconstructive management of cranial base defects after tumor ablation. Plast Reconstr Surg 2001; 107 (06) 1346-1355 ; discussion 1356–1357
    CrossrefPubMedGoogle Scholar
  • 34 Clayman GL, DeMonte F, Jaffe DM. , et al. Outcome and complications of extended cranial-base resection requiring microvascular free-tissue transfer. Arch Otolaryngol Head Neck Surg 1995; 121 (11) 1253-1257
    CrossrefPubMedGoogle Scholar
  • 35 Teknos TN, Smith JC, Day TA, Netterville JL, Burkey BB. Microvascular free tissue transfer in reconstructing skull base defects: lessons learned. Laryngoscope 2002; 112 (10) 1871-1876
    CrossrefPubMedGoogle Scholar
  • 36 Inman J, Ducic Y. Intracranial free tissue transfer for massive cerebrospinal fluid leaks of the anterior cranial fossa. J Oral Maxillofac Surg 2012; 70 (05) 1114-1118
    CrossrefPubMedGoogle Scholar
  • 37 Iida T, Mihara M, Yoshimatsu H. , et al. Reconstruction of an extensive anterior skull base defect using a muscle-sparing rectus abdominis myocutaneous flap in a 1-year-old infant. Microsurgery 2012; 32 (08) 622-626
    CrossrefPubMedGoogle Scholar
  • 38 Low TH, Lindsay A, Clark J, Chai F, Lewis R. Reconstruction of maxillary defect with musculo-adipose rectus free flap. Microsurgery 2017; 37 (02) 137-141
    CrossrefPubMedGoogle Scholar
  • 39 Pryor SG, Moore EJ, Kasperbauer JL. Orbital exenteration reconstruction with rectus abdominis microvascular free flap. Laryngoscope 2005; 115 (11) 1912-1916
    CrossrefPubMedGoogle Scholar
  • 40 Hanasono MM, Sacks JM, Goel N, Ayad M, Skoracki RJ. The anterolateral thigh free flap for skull base reconstruction. Otolaryngol Head Neck Surg 2009; 140 (06) 855-860
    CrossrefPubMedGoogle Scholar
  • 41 Karonidis A, Chang LR. Using the distal part of vastus lateralis muscle as chimeric anterolateral thigh free flap is a more flexible tool for head and neck reconstruction. Eur J Plast Surg 2010; 33 (01) 1-5
    CrossrefPubMedGoogle Scholar
  • 42 Ali RS, Bluebond-Langner R, Rodriguez ED, Cheng M-H. The versatility of the anterolateral thigh flap. Plast Reconstr Surg 2009; 124 (6, Suppl) e395-e407
    CrossrefPubMedGoogle Scholar
  • 43 Coskunfirat OK, Özkan O. Free tensor fascia lata perforator flap as a backup procedure for head and neck reconstruction. Ann Plast Surg 2006; 57 (02) 159-163
    CrossrefPubMedGoogle Scholar
  • 44 Schwartz MS, Cohen JI, Meltzer T. , et al. Use of the radial forearm microvascular free-flap graft for cranial base reconstruction. J Neurosurg 1999; 90 (04) 651-655
    CrossrefPubMedGoogle Scholar
  • 45 Knott PD, Suh JD, Nabili V. , et al. Evaluation of hardware-related complications in vascularized bone grafts with locking mandibular reconstruction plate fixation. Arch Otolaryngol Head Neck Surg 2007; 133 (12) 1302-1306
    CrossrefPubMedGoogle Scholar
  • 46 Deutsch M, Kroll SS, Ainsle N, Wang B. Influence of radiation on late complications in patients with free fibular flaps for mandibular reconstruction. Ann Plast Surg 1999; 42 (06) 662-664
    CrossrefPubMedGoogle Scholar
  • 47 Futran ND, Wadsworth JT, Villaret D, Farwell DG. Midface reconstruction with the fibula free flap. Arch Otolaryngol Head Neck Surg 2002; 128 (02) 161-166
    CrossrefPubMedGoogle Scholar
  • 48 Anthony JP, Foster RD, Sharma AB, Kearns GJ, Hoffman WY, Pogrel MA. Reconstruction of a complex midfacial defect with the folded fibular free flap and osseointegrated implants. Ann Plast Surg 1996; 37 (02) 204-210
    CrossrefPubMedGoogle Scholar
  • 49 Civantos FJ. Latissimus dorsi microvascular flap. Facial Plast Surg 1996; 12 (01) 65-68
    Article in Thieme ConnectPubMedGoogle Scholar
  • 50 Sullivan MJ, Carroll WR, Baker SR, Crompton R, Smith-Wheelock M. The free scapular flap for head and neck reconstruction. Am J Otolaryngol 1990; 11 (05) 318-327
    CrossrefPubMedGoogle Scholar
  • 51 Zinreich SJ, Mattox DE, Kennedy DW. , et al. 3-D CT for cranial facial and laryngeal surgery. Laryngoscope 1988; 98 (11) 1212-1219
    PubMedGoogle Scholar
  • 52 Herman GT, Liu HK. Three-dimensional display of human organs from computed tomograms. Comput Graph Image Process 1979; 9 (01) 1-21
    CrossrefPubMedGoogle Scholar
  • 53 Rosahl SK, Gharabaghi A, Hubbe U, Shahidi R, Samii M. Virtual reality augmentation in skull base surgery. Skull Base 2006; 16 (02) 59-66
    Article in Thieme ConnectPubMedGoogle Scholar
  • 54 Markiewicz MR, Bell RB. The use of 3D imaging tools in facial plastic surgery. Facial Plast Surg Clin North Am 2011; 19 (04) 655-682 , ix
    CrossrefPubMedGoogle Scholar
  • 55 Levine JP, Patel A, Saadeh PB, Hirsch DL. Computer-aided design and manufacturing in craniomaxillofacial surgery: the new state of the art. J Craniofac Surg 2012; 23 (01) 288-293
    CrossrefPubMedGoogle Scholar
  • 56 Schipper J, Ridder GJ, Spetzger U, Teszler CB, Fradis M, Maier W. Individual prefabricated titanium implants and titanium mesh in skull base reconstructive surgery. A report of cases. Eur Arch Otorhinolaryngol 2004; 261 (05) 282-290
    CrossrefPubMedGoogle Scholar
  • 57 Saigal K, Winokur RS, Finden S, Taub D, Pribitkin E. Use of three-dimensional computerized tomography reconstruction in complex facial trauma. Facial Plast Surg 2005; 21 (03) 214-220
    Article in Thieme ConnectPubMedGoogle Scholar
  • 58 Haerle SK, Daly MJ, Chan HHL, Vescan A, Kucharczyk W, Irish JC. Virtual surgical planning in endoscopic skull base surgery. Laryngoscope 2013; 123 (12) 2935-2939
    CrossrefPubMedGoogle Scholar
  • 59 Marcus HJ, Pratt P, Hughes-Hallett A. , et al. Comparative effectiveness and safety of image guidance systems in neurosurgery: a preclinical randomized study. J Neurosurg 2015; 123 (02) 307-313
    CrossrefPubMedGoogle Scholar
  • 60 Sefcik RK, Rasouli J, Bederson JB, Shrivastava RK. Three-dimensional, computer simulated navigation in endoscopic neurosurgery. Interdiscip Neurosurg 2017; 8: 17-22
    PubMedGoogle Scholar
  • 61 Seymour NE, Gallagher AG, Roman SA. , et al. Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 2002; 236 (04) 458-463 ; discussion 463–464
    CrossrefPubMedGoogle Scholar
  • 62 Alaraj A, Lemole MG, Finkle JH. , et al. Virtual reality training in neurosurgery: Review of current status and future applications. Surg Neurol Int 2011; 2: 52
    CrossrefPubMedGoogle Scholar
  • 63 Stadie AT, Kockro RA, Reisch R. , et al. Virtual reality system for planning minimally invasive neurosurgery. Technical note. J Neurosurg 2008; 108 (02) 382-394
    CrossrefPubMedGoogle Scholar
  • 64 Schirmer CM, Mocco J, Elder JB. Evolving virtual reality simulation in neurosurgery. Neurosurgery 2013; 73 (Suppl. 01) 127-137
    CrossrefPubMedGoogle Scholar
  • 65 Xia T, Baird C, Jallo G. , et al. An integrated system for planning, navigation and robotic assistance for skull base surgery. Int J Med Robot 2008; 4 (04) 321-330
    CrossrefPubMedGoogle Scholar