Approaches and reconstruction in skull base operation.

OBJECTIVE

To design convenient lateronasal and infrafrontal approaches or lateronasal subvolution approach to radically resect skull base tumors involving cranial cavity.

METHODS

From 1987 through 1994, 22 patients with malignant tumors, 6 with benign tumors, one with a giant sphenoid sinus cyst and one with intranasal meningoencephalocele underwent the operation. Twenty-three cases had anterocranial fossa involved; 4, midcranial fossa; 2, anteromedial cranial fossa; and 1 case, posteromedial cranial fossa. Among the patients with malignant tumors, 11 underwent expansive maxillectomy and 10 had orbital contents resected. The intracranial approaches through lateronasal and infrafront (21 cases), nasal columella lateral subvolution (3 cases) and other approaches were used.

RESULTS

The reconstruction of bony skull base defect in excess of 3.00 cm x 3.00 cm with total front musculocutaneous flap (8 cases), galeal and pericranial flap (5 cases) or other tissues (3 cases) has effectively prevented meningoencephalocele. Twelve cases had the dura resected in a range of 2.00 cm x 2.00 cm to 7.00 cm x 6.00 cm. Reconstruction of the dura defect with autofascia lata in 9 cases and other tissues in 3 cases effectively prevented the cerebrospinal fluid leak. Eight of 22 (36.4%) patients with malignant tumors have been alive and free of disease for 3-7 years after the operation. Six patients with benign tumors, one patient with giant sphenoid sinus cyst and one with meningoencephalocele were cured with this reconstructing method.

CONCLUSIONS

Frontal musculocutaneous and pericranial flaps have advantages over free bone because of easy surviving and easy operating without occurrence of osteonecrosis and exclusive reaction.