Anterior Skull Base Reconstruction with Intracranial Free Flaps

Abstract

Reconstruction of the skull base is of vital importance to avoid life-threatening complications after surgery. A successful skull base reconstruction results in a watertight repair of the dura defect, interposition of vascularized tissue between exposed dura and subjacent spaces, filling of dead space, reconstruction of bony structures, and inner and outer lining and cranial nerve reconstruction if required. This chapter includes a case in which a chimeric anterolateral thigh flap was used to reconstruct a defect of the anterior skull base and enucleation of the right eye after resection of an aggressive meningioma. An adipofascial component with intracranial insetting was used to seal the dura defect, and a muscle component was used to seal the central defect of the anterior skull base. Additionally, a small cutaneous skin island was left in the eye for flap monitoring. Alternative free flaps include any combination of the thoracodorsal artery system or flaps of the arm. In case of moderate to large defects or if postoperative radiotherapy may be needed, locoregional options should not be considered as a feasible alternative for microvascular reconstructions given the high complication rates. Generally speaking, early complications include intracranial complications such as cerebrospinal fluid (CSF) leakage and infectious complications and thrombotic, respiratory, or cardiac complications.