REPAIR OF ANTERIOR BASE OF SKULL WITH FREE LATISSIMUS-DORSI FLAP

After craniofacial resection for ethmoid and nasal cancer the resultin g defect in the anterior base of skull often is a problem because of l iquorrhoea, followed by meningitis and brain herniation. Two approache s were used for surgery of ethmoid and nasal cancer involving the ante rior base of skull - the transfrontal and the transethmoidal. The neur osurgeon performs the transfrontal approach, an additional lateral rhi notomy and ethmoidectomy is made by the ENT-surgeon. Seven patients un derwent radical operation with immediate repair of the skull base defe ct performed in four and delayed repair in three cases with a microvas cular latissimus dorsi muscle flap. The flap was tailored as a pure mu scle transplant if only the base of skull had to be repaired and the s urgical cavity had to be obliterated. In three cases a skin paddle was left on the muscle to perform closure of the orbit and of the hard pa late. The aim of reconstruction is a good functional and cosmetic resu lt and reduction of postoperative problems - such as brain herniation, CSF-leakage and meningitis - by obliteration of surgical cavities. Fu rthermore crusting of large cavities and disorders of phonation are re duced. The disadvantage of limited direct postoperative tumour control by nasal endoscopy however is justified by an increase of quality of life.