RECONSTRUCTION OF THE ANTERIOR CRANIAL BASE WITH THE GALEAL FRONTALISMYOFASCIAL FLAP AND THE VASCULARIZED OUTER TABLE CALVARIAL BONE-GRAFT

RECONSTRUCTION OF THE anterior cranial base after tumor extirpation mu st seal off the cranial cavity from the upper respiratory tract. The k ey to success is to use vascularized materials for the structural supp ort of the brain. from October 1989 to July 1992, in patients underwen t anterior cranial base reconstruction after basicranial tumor resecti on; the lesions were four meningiomas and six malignant tumors of the ethmoid, maxilla, and orbit. The malignant tumors included four recurr ent tumors that had been previously treated by a transfacial approach. After tumor extirpation, the resultant bony defects in the anterior c ranial base, involving the orbital roof as well as the cribriform plat e, ranged from 4 x 3 to 6 x 7 cm in size. The materials used in recons truction were the galeal frontalis myofascial flap and the outer table calvarial bone flap, which is based on the temporoparietal galeal fla p. Both materials are known to have rich blood supplies. These flaps m ake a reliable separation between the cranial cavity and the respirato ry tract in three layers: the galeal frontalis myofascial flap, the va scularized calvarial bone, and the temporoparietal galea. Postoperativ e complications included one subcutaneous hematoma and one temporary c erebrospinal fluid rhinorrhea. We think this reconstructive technique will be useful in selected circumstances, especially after resection o f a recurrent malignant tumor.