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J Neurol Surg B Skull Base 2022; 83(04): 359-366
DOI: 10.1055/s-0041-1722899
Original Article

Reconstructive Outcomes of Multilayered Closure of Large Skull Base Dural Defects Following Open Anterior Craniofacial Resection

Justin Shi
1   Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
,
Tokunbo Ayeni
1   Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
,
Kathleen Kelly Gallagher
1   Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
,
Akash J. Patel
1   Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
2   Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
3   Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas, United States
,
Ali Jalali
2   Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
,
David J. Hernandez
1   Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
,
Angela D. Haskins
1   Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
,
Vlad C. Sandulache
1   Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
,
Erich M. Sturgis
1   Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
,
Andrew T. Huang
1   Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
› Author Affiliations Funding None.
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Abstract

Introduction Standardized reconstruction protocols for large open anterior skull base defects with dural resection are not well described. Here we report the outcomes and technique of a multilayered reconstructive algorithm utilizing local tissue, dural graft matrix, and microvascular free tissue transfer (MVFTT) for reconstruction of these deformities.

Design This study is a retrospective review.

Results Eleven patients (82% males) met inclusion criteria, with five (45%) having concurrent orbital exenteration and eight (73%) requiring maxillectomy. All patients required dural resection with or without intracranial tumor resection, with the average dural defect being 36.0 ± 25.9 cm2. Dural graft matrices and pericranial flaps were used for primary reconstruction of the dural defects, which were then reinforced with free fascia or muscle overlay by means of MVFTT. Eight (73%) patients underwent anterolateral thigh MVFTT, with the radial forearm, fibula, and vastus lateralis comprising the remainder. Average total surgical time of tumor resection and reconstruction was 14.9 ± 3.8 hours, with median length of hospitalization being 10 days (IQR: 9.5, 14). Continuous cerebrospinal fluid drainage through a lumber drain was utilized in 10 (91%) patients perioperatively, with an average length of indwelling drain of 5 days. Postoperative complications occurred in two (18%) patients who developed asymptomatic pneumocephalus that resolved with high-flow oxygen therapy.

Conclusion A standardized multilayered closure technique of dural graft matrix, pericranial flap, and MVFTT overlay in the reconstruction of large open anterior craniofacial dural defects can assist the reconstructive team in approaching these complex deformities and may help prevent postoperative complications.

Keywords

head and neck cancer - anterior craniofacial resection - skull base - reconstruction - microvascular free tissue transfer

Note

This research was presented at the American Academy of Facial Plastic and Reconstructive Surgery Annual Meeting in San Diego, California, October 3 to 5, 2019.




Publication History

Received: 21 August 2020

Accepted: 27 November 2020

Article published online:
22 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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