Anterior Skull Base Reconstruction after Craniofacial Resection

Objective: Presentation of anterior skull base reconstruction after craniofacial resection and after large traumatic loss of skull base bones. Methods: The retrospective study of clinical course in patients who underwent the reconstructive procedure for the skull base defect. The tumor resection included malignant and benign tumors invading from bellow and meningiomas invading anterior skull base. The posttraumatic defects included only defects over 25mm with the brain herniation. Following duraplasty anterior skull base defects were reconstructed by a three-layer method: vascularized pericranial flap for upper level, than a split calvarial bone grafts for full bone defect closure and pericranial flap or rotational mucosal flap as the outer layer toward nasal cavity. Facial reconstruction was performed in relation to the defect with calvarial bone grafts and/or titanium mesh for bone defects. Follow-up of more than 1 year was compared with the patients with similar resection and soft reconstruction only (without skull base bone grafting). Results: In patients with three layer reconstruction we did not observe late cerebrospinal fluid leak, intracranial infection, tension pneumocephalus or brain herniation. Conclusion: A three-layer reconstruction (soft/bone/soft) of the anterior skull base is a reliable method for the closure of craniofacial communication to avoid later complications.