Microvascular Reconstruction of the Anterior Skull Base

Nwaba, Adaure; Ho, Alisha; Ellis, Marco F.

doi:10.1097/scs.0000000000008930

Cited by 3 publications

(3 citation statements)

References 18 publications

(54 reference statements)

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“…While microvascular free flaps are effective in the primary reconstruction of oncologic defects, their use in the treatment of anterior skull base ORN is still less commonly implored. 7,[10][11][12][13][14][15] Here we describe the use of an anterolateral thigh free flap to successfully treat delayed onset ORN following basaloid squamous cell carcinoma (BSCC) of the sinonasal cavity. With eight reported cases in the English medical literature of extensive anterior skull base reconstruction by a microvascular free flap for osteoradionecrosis we present an important experience herein.…”

Section: Introductionmentioning

confidence: 99%

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Multidisciplinary Management of Total Anterior Skull Base Osteoradionecrosis

Dhanda,

McKee,

Allen

et al. 2023

J Neurol Surg Rep

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Cases of delayed osteoradionecrosis (ORN) of the anterior skull base have unique management considerations. A 59-year-old woman with a history of basaloid squamous cell carcinoma of the sinonasal cavity with intracranial extension through the anterior skull base developed delayed radiation sequelae of anterior skull base ORN. She underwent an initial endoscopic resection in 2011 with persistent disease that required an anterior craniofacial resection with left maxillectomy in 2012 followed by adjuvant chemoradiotherapy. She subsequently developed an intracranial abscess in 2021 along the anterior skull base that required a craniotomy and endoscopic debridement. Despite aggressive surgical and medical therapy, she had persistent intracranial infections and evidence of skull base osteoradionecrosis. She ultimately underwent a combined open bifrontal craniotomy and endoscopic resection of the necrotic frontal bone and dura followed by an anterolateral thigh free flap reconstruction with titanium mesh cranioplasty. The patient recovered well from a microvascular free-tissue reconstruction without concern for cerebrospinal fluid leak. Anterior skull base reconstruction with free tissue transfer is a commonly utilized method for oncologic resections. Here, an anterolateral free flap was effectively used to treat an anterior skull base defect secondary to a rare indication of skull base osteoradionecrosis.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Multidisciplinary Management of Total Anterior Skull Base Osteoradionecrosis

Dhanda,

McKee,

Allen

et al. 2023

J Neurol Surg Rep

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“…Nasocranial fistulae in the setting of prior radiation and multiple operations represent a unique treatment challenge. 1,2 Reconstruction aims to separate the intracranial contents from the extracranial contents. 3 Radiation delivered to the tumor bed limits the ability to use local and regional flaps for reconstruction.…”

mentioning

confidence: 99%

Staged Intracranial Free Tissue Transfer and Cranioplasty for a Refractory Nasal-cranial Base Fistula

Emanuels,

Cherukuri,

Van Gompel

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Summary: After a transnasal endoscopic resection of a high-grade adenoid cystic carcinoma that underwent adjuvant chemoradiation, there was delayed recurrence managed by en bloc resection through an open craniofacial approach. Subsequently, the patient developed a chronic nasocranial fistula with secondary infection and bone flap resorption. This resulted in infectious episodes with secondary scalp incisional dehiscence and hardware exposure which required multiple bone debridement procedures, hardware removal, prolonged IV antibiotics, and hyperbaric oxygen treatment. The nasocranial fistula and chronic frontal bone osteomyelitis persisted despite the previous interventions. The patient underwent a frontal bone removal and obliteration of the anterior cranial base fistula with a free vastus lateralis muscle flap. At 4 weeks postoperatively, the intranasal portion of the muscle flap had completely mucosalized. After a 6-week course of IV antibiotics, a secondary cranioplasty using a custom-made poly-ether-ether-ketone implant was performed. The patient remained disease- and infection-free for the duration of follow-up (17 months).

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