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DOI: 10.1055/s-0039-1679785
Salvage Vastus Lateralis Free Tissue Transfer for Postoperative CSF Leaks after Multiple Redo-Surgeries and Proton Beam Radiotherapy for Clival Chordoma
Publikationsverlauf
Publikationsdatum:
06. Februar 2019 (online)
Case report of a 56-year-old patient who was suffering from chronic headaches and tongue deviation to the right. A Cervical MRI showed a well-defined lesion at the craniocervical junction compatible with chordoma. He underwent several surgeries and received two rounds of Proton Beam Radiotherapy. Because of that, the patient suffered from osteonecrosis of the skull base and CSF leak more than one year after the first surgery. Skull base reconstruction using vastus lateralis free tissue transfer was used after failed multiple trials to seal the defect using local vascular flap and fat graft. Vascular free flaps are preferred over local or regional flaps in the reconstruction of skull base defects (secondary to postradiotherapy osteonecrosis), since radiotherapy compromises the vascularity of local and regional flaps. More than 6 weeks after the surgery, at the rhinoscopy, we could notice the surrounding mucosa in-growing into the flap and no sign of CSF leak.
We described the technique (from free flap harvest till its insertion inside the nose, to stop the CSF leak) with the pictures of the main moments
In conclusion, Microvascular free flaps are better alternatives (than local and regional flaps) for the reconstruction of skull base defects in patients with skull base tumors who underwent surgery and received Radiotherapy. Skull base reconstruction using vastus lateralis free tissue transfer is a good option for the repair of middle skull base defects secondary to osteoradionecrosis
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