Microvascular reconstruction of the skull base: Indications and procedures

Purpose: The aim of the current study was to review the use of; free tissue transfer for reconstruction of the skull base and for coverage of intracra nial contents. Patients and Methods: From 1990 until 1996, revascularized flaps were trans ferred to the skull and the skull base in 11 patients in whom intracranial/ extracranial resection of tumors of the skull base was performed in coopera tion with the Department of Neurosurgery. The defects resulted from removal of squamous cell carcinomas (n = 4), basal cell carcinomas (n = 4), malign ant melanoma, malignant schwannoma, and malignant meningioma. Defect repair was accomplished by revascularized transfer of latissimus dorsi muscle fla ps in seven cases and rectus abdominis flaps and forearm flaps in two cases each. In five patients with extensive intracranial tumor spread, reconstru ction was performed for palliative reasons. Results: A safe soft tissue closure of the intracranial and intradural spac e was achieved in all patients, whereas the contour of the facial skull and the neurocranium was satisfactorily restored at the same time. By using th e entire length of the grafted muscle, the vascular pedicle could be positi oned next to the external carotid artery and conveniently connected to the cervical vessels. The mean survival time of the patients with palliative tr eatment was 8.4 months, with an average duration of hospital stay of 24.5 d ays. Conclusions: Despite the increased surgical effort of revascularized tissue transfer, microvascular reconstruction of large skull base defects appears to be justified, even as a palliative measure.