Contemporary skull base reconstruction

Abstract

Purpose of review: Tumors of the skull base that would have been considered inoperable thirty or forty years ago are now routinely resected with reliable results due to the advancement of modern reconstructive techniques. High mortality rates were common prior to the use of vascularized tissue for skull base repair. However, the advent of local flap reconstruction for skull base defects in the 1960s revolutionized skull base surgery. The use of regional flaps in the 1970s and 1980s allowed skull base surgeons to perform more extensive surgeries, but complication rates were still quite high.

Recent findings: Experience with free tissue reconstruction increased through the 1980s and 1990s and has become a reliable method to separate the intracranial from extracranial environments. Free tissue transfer has allowed surgeons to address the large volume defects created by extensive skull base resections and has provided dependable, vascularized tissue that is relatively resistant to adjuvant radiation. Local flaps have also become a powerful reconstructive tool in conjunction with free tissue transfer, and in some select cases, may be sufficient alone for reconstruction.

Summary: The prevention of serious complications after skull surgery has improved with the use of vascularized tissue. Depending on the anatomic site, the extent of the defect, and the quality of local tissues, either free tissue transfer and/or local flap reconstruction is preferred. Regional flap reconstruction should be reserved for cases where alternative reconstructive techniques are not available.