Iliac Bone Graft Reconstruction of the Floor of the Anterior Cranial Fossa

Resection of anterior cranial fossa tumors, traumatic head injuries, and craniotomies for other purposes can result in anterior cranial fossa floor defects. Communication between the anterior cranial fossa and nasopharynx often causes pneumocephalus, cerebrospinal fluid rhinorrhea, and intracranial infections. A variety of techniques, including pericranial flaps, galeal flaps, temporalis fascial flaps, split rib, and calvaria grafts have been used to reconstruct anterior cranial fossa floor defects. The purpose of this study was to investigate the utility of autogeneous iliac bone grafts with a galeal flap in the reconstruction of this type of cranial defect. This new technique was employed in the treatment of two patients who suffered recurrent pneumocephalus and intracranial infections secondary to anterior cranial fossa floor defects that resulted from a head injury in one patient, and aneurysm clipping operation in the other. At surgery, the cortical layer of the iliac bone graft was removed, leaving only cancerous bone. The graft was packed tightly into the anterior cranial fossa defect with cancerous bone chips. A vasculalized galeal flap was placed over the graft. Follow-up examination of the two patients at 6 and 12 months demonstrated bone integrity in the anterior fossa floor and graft viability. Neither patient suffered late complications. In summary, the iliac bone graft is ideal for the reconstruction of anterior fossa floor defects because it is possible to obtain a sufficient quantity of cancerous bone to fill the gap, it is easy to shape the graft, cancerous bone demonstrates excellent bony fusion and infection resistance, and the completed reconstruction provides a rigid bony barrier between the anterior cranial fossa and the nasopharynx.