Reconstruction Outcomes Following Lateral Skull Base Resection

Abstract

Objective: Compare reconstruction outcomes for various lateral skull base closure techniques.

Study design: Retrospective medical records review.

Setting: University-based tertiary referral center.

Patients: Patients who underwent resections of tumors involving the lateral skull base requiring reconstruction beyond primary closure.

Intervention(s): Reconstructive techniques, from rotational flaps to free tissue transfer.

Main outcome measure(s): Outcome data including wound complications, cerebrospinal fluid (CSF) leakage, and need for surgical revision were tabulated.

Results: Eighty-six patients underwent lateral skull base tumor resection and reconstruction. Procedures were primarily lateral temporal bone resections but also included subtotal temporal bone, total temporal bone, and infratemporal fossa resections. Cutaneous malignancy was the most common resection indication (83%) and the temporalis rotational flap was the most commonly employed reconstructive option (30%). When free tissue transfer techniques were used, the radial forearm, anterolateral thigh, and latissimus dorsi were the most frequent donor sites. Patients with T2 disease were more likely to undergo temporalis flaps, whereas patients with T4 disease were more likely to undergo free flap reconstruction. Major complications were uncommon (∼8%), the most frequent being stroke (∼3%). The postoperative wound complication rate was approximately 45%. The majority involved minor dehiscences and were managed conservatively. Patients with T4 disease were more likely to have wound complications (p < 0.05). Radial forearm free flaps were less likely to have wound complications when compared with other reconstruction techniques (p < 0.05).

Conclusions: Many factors go into planning lateral skull base reconstruction. Free flaps were more often used for T4 disease. Radial forearm free flaps tended to have lower wound complication rates when compared with other techniques.

FIG. 1.

Reconstruction type by defect size. ALT indicates anterolateral thigh; LD, latissimus dorsi; RF, radial forearm; SM, submental; T, temporalis.