Skip to main content
Erschienen in: Journal of Neuro-Oncology 3/2020

13.02.2020 | Topic Review

Reconstruction after open surgery for skull-base malignancies

verfasst von: Matthew M. Hanasono

Erschienen in: Journal of Neuro-Oncology | Ausgabe 3/2020

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Resection of skull base malignancies that would have been associated with unacceptable morbidity and mortality in the past are now performed with reliable results due in large part to advancements in reconstructive surgery. The goal of this review is to describe the best evidence-based methods of reconstruction following open surgery for skull base tumors in order to attain improved outcomes for patients.

Methods

A review of recent studies involving reconstruction following open skull base surgeries was performed.

Results

Free flaps are now the most commonly recommended method for reconstruction following open skull base surgery, although pedicled regional flaps such as the temporalis muscle, supraclavicular, and submental flaps may be good alternatives in specific cases. Recent series suggest high reconstructive free flap survival rates and low levels of recipient site complications, including neurosurgical complications such as cerebrospinal fluid leak. The location of the resection defect predicts the reconstructive challenges and guides pedicled and free flap selection.

Conclusion

Refinements in flap selection and reconstructive technique continue to improve patient outcomes and decrease complication rates following open surgery for skull base malignancies.
Literatur
1.
Zurück zum Zitat Riley CA, Tabaee A, Conley L et al (2019) Long-term sinonasal outcomes after endoscopic skull base surgery with nasoseptal flap reconstruction. Laryngoscope 129:1035–1040PubMed Riley CA, Tabaee A, Conley L et al (2019) Long-term sinonasal outcomes after endoscopic skull base surgery with nasoseptal flap reconstruction. Laryngoscope 129:1035–1040PubMed
2.
Zurück zum Zitat Safavi-Abbasi S, Komune N, Archer JB et al (2016) Surgical anatomy and utility of pedicled vascularized tissue flaps for multilayered repair of skull base defects. J Neurosurg 125:419–430PubMed Safavi-Abbasi S, Komune N, Archer JB et al (2016) Surgical anatomy and utility of pedicled vascularized tissue flaps for multilayered repair of skull base defects. J Neurosurg 125:419–430PubMed
3.
Zurück zum Zitat Veyrat M, Verillaud B, Herman P, Breeson D (2016) How I do it. The pedicled temporoparietal fascial flap for skull base reconstruction after endonasal endoscopic approaches. Acta Neurochir 158:2291–2294PubMed Veyrat M, Verillaud B, Herman P, Breeson D (2016) How I do it. The pedicled temporoparietal fascial flap for skull base reconstruction after endonasal endoscopic approaches. Acta Neurochir 158:2291–2294PubMed
4.
Zurück zum Zitat Moyer JS, Chepeha DB, Teknos TN (2004) Contemporary skull base reconstruction. Curr Opin Otolaryngol Head Neck Surg 12:294–299PubMed Moyer JS, Chepeha DB, Teknos TN (2004) Contemporary skull base reconstruction. Curr Opin Otolaryngol Head Neck Surg 12:294–299PubMed
5.
Zurück zum Zitat Hanasono MM, Silva AK, Skoracki RJ et al (2011) Skull base reconstruction: an updated approach. Plast Reconstr Surg 128:675–686PubMed Hanasono MM, Silva AK, Skoracki RJ et al (2011) Skull base reconstruction: an updated approach. Plast Reconstr Surg 128:675–686PubMed
6.
Zurück zum Zitat Neligan PC, Mulholland S, Irish J et al (1996) Flap selection in cranial base reconstruction. Plast Reconstr Surg 98:1159–1166PubMed Neligan PC, Mulholland S, Irish J et al (1996) Flap selection in cranial base reconstruction. Plast Reconstr Surg 98:1159–1166PubMed
7.
Zurück zum Zitat Jones NF, Schramm VL, Sekhar LN (1987) Reconstruction of the cranial base following tumour resection. Br J Plast Surg 40:155–162PubMed Jones NF, Schramm VL, Sekhar LN (1987) Reconstruction of the cranial base following tumour resection. Br J Plast Surg 40:155–162PubMed
8.
Zurück zum Zitat Irish J, Gullane PJ, Gentili F et al (1994) Tumors of the skull base: outcome and survival analysis of 77 cases. Head Neck 16:3–10PubMed Irish J, Gullane PJ, Gentili F et al (1994) Tumors of the skull base: outcome and survival analysis of 77 cases. Head Neck 16:3–10PubMed
9.
Zurück zum Zitat Hanasono MM, Silva AK, Yu P, Skoracki RJ, Sturgis EM, Gidley PW (2012) Comprehensive management of temporal bone defects after oncologic resection. Laryngoscope 122:2663–2669PubMed Hanasono MM, Silva AK, Yu P, Skoracki RJ, Sturgis EM, Gidley PW (2012) Comprehensive management of temporal bone defects after oncologic resection. Laryngoscope 122:2663–2669PubMed
10.
Zurück zum Zitat Heth JA, Funk GF, Karnell LH et al (2002) Free tissue transfer and local flap complications in anterior and anterolateral skull base surgery. Head Neck 24:901–912PubMed Heth JA, Funk GF, Karnell LH et al (2002) Free tissue transfer and local flap complications in anterior and anterolateral skull base surgery. Head Neck 24:901–912PubMed
11.
Zurück zum Zitat Califano J, Cordeiro PG, Disa JJ et al (2003) Anterior cranial base reconstruction using free tissue transfer: changing tends. Head Neck 25:89–96PubMed Califano J, Cordeiro PG, Disa JJ et al (2003) Anterior cranial base reconstruction using free tissue transfer: changing tends. Head Neck 25:89–96PubMed
12.
Zurück zum Zitat Pangrazi PP, De Francesco F, Di Rienzo A, Riccio M (2019) Adipofascial radial forearm free flap for anterior skull base reconstruction in complicated forebrain oncological surgery. J Cranio Maxillofac Surg 30:1724–1729 Pangrazi PP, De Francesco F, Di Rienzo A, Riccio M (2019) Adipofascial radial forearm free flap for anterior skull base reconstruction in complicated forebrain oncological surgery. J Cranio Maxillofac Surg 30:1724–1729
13.
Zurück zum Zitat Hanasono MM, Sacks JM, Goel N, Ayad M, Skoracki RJ (2009) The anterolateral thigh free flap for skull base reconstruction. Otolaryngol Head Neck Surg 140:855–860PubMed Hanasono MM, Sacks JM, Goel N, Ayad M, Skoracki RJ (2009) The anterolateral thigh free flap for skull base reconstruction. Otolaryngol Head Neck Surg 140:855–860PubMed
14.
Zurück zum Zitat Girod A, Boissonnet H, Jouffroy T, Rodriguez J (2012) Latissimus dorsi free flap reconstruction of anterior skull base defects. J Cranio-MaxFac Surg 40:177–179 Girod A, Boissonnet H, Jouffroy T, Rodriguez J (2012) Latissimus dorsi free flap reconstruction of anterior skull base defects. J Cranio-MaxFac Surg 40:177–179
15.
Zurück zum Zitat Paprottka FJ, Krezdorn N, Ipaktchi R, Radtke C, Vogt PM (2016) Plastic reconstructive surgery technique for defect coverage of extended skull base defects. J Plast Reconstr Aesthet Surg 69:1266–1274PubMed Paprottka FJ, Krezdorn N, Ipaktchi R, Radtke C, Vogt PM (2016) Plastic reconstructive surgery technique for defect coverage of extended skull base defects. J Plast Reconstr Aesthet Surg 69:1266–1274PubMed
16.
Zurück zum Zitat Hasan Z, Gore SM, Ch’ng S, Ashford B, Clark JR (2013) Options for configuring the scapular free flap in maxillary, mandibular, and calvarial reconstruction. Plast Reconstr Surg 132: 645–655.PubMed Hasan Z, Gore SM, Ch’ng S, Ashford B, Clark JR (2013) Options for configuring the scapular free flap in maxillary, mandibular, and calvarial reconstruction. Plast Reconstr Surg 132: 645–655.PubMed
17.
Zurück zum Zitat Hanasono MM, Utley DS, Goode RL (2001) The temporalis muscle flap for reconstruction after head and neck oncologic surgery. Laryngoscope 111:1719–1725PubMed Hanasono MM, Utley DS, Goode RL (2001) The temporalis muscle flap for reconstruction after head and neck oncologic surgery. Laryngoscope 111:1719–1725PubMed
18.
Zurück zum Zitat Hanasono MM, Lee JC, Yang JS, Skoracki RJ, Reece GP, Esmaeli B (2009) An algorithmic approach to reconstructive surgery and prosthetic rehabilitation after orbital exenteration. Plast Reconstr Surg 123:98–105PubMed Hanasono MM, Lee JC, Yang JS, Skoracki RJ, Reece GP, Esmaeli B (2009) An algorithmic approach to reconstructive surgery and prosthetic rehabilitation after orbital exenteration. Plast Reconstr Surg 123:98–105PubMed
19.
Zurück zum Zitat Chiu ES, Kraus D, Bui DT et al (2008) Anterior and middle cranial fossa skull base reconstruction using microvascular free tissue techniques. Ann Plast Surg 60:514–520PubMed Chiu ES, Kraus D, Bui DT et al (2008) Anterior and middle cranial fossa skull base reconstruction using microvascular free tissue techniques. Ann Plast Surg 60:514–520PubMed
20.
Zurück zum Zitat Moiyadi AV, Ghazwan A, Pai PS, Kelkar G, Nair D, Yadav PS (2012) Free anterolateral thigh flap for reconstruction of complex craniofacial defects after resection of tumors of the fronto-orbitomaxillary complex. J Craniofac Surg 23:836–841PubMed Moiyadi AV, Ghazwan A, Pai PS, Kelkar G, Nair D, Yadav PS (2012) Free anterolateral thigh flap for reconstruction of complex craniofacial defects after resection of tumors of the fronto-orbitomaxillary complex. J Craniofac Surg 23:836–841PubMed
21.
Zurück zum Zitat Aksu AE, Uzun K, Bitik O, Tuncbilek G, Safak T (2017) Microvascular tissue transfers for midfacial and anterior cranial base reconstruction. J Craniofac Surg 28:659–663PubMed Aksu AE, Uzun K, Bitik O, Tuncbilek G, Safak T (2017) Microvascular tissue transfers for midfacial and anterior cranial base reconstruction. J Craniofac Surg 28:659–663PubMed
22.
Zurück zum Zitat Amin A, Rifaat M, Civantos F, Weed D, Abu-Sedira M, Bassiouny M (2006) Free anterolateral thigh flap for reconstruction of major craniofacial defects. J Reconstr Microsurg 22:97–104PubMed Amin A, Rifaat M, Civantos F, Weed D, Abu-Sedira M, Bassiouny M (2006) Free anterolateral thigh flap for reconstruction of major craniofacial defects. J Reconstr Microsurg 22:97–104PubMed
23.
Zurück zum Zitat Thakker JS, Fernandes R (2014) Evaluation of reconstructive techniques for anterior and middle skull base defects following tumor ablation. J Oral Maxillofac Surg 72:198–204PubMed Thakker JS, Fernandes R (2014) Evaluation of reconstructive techniques for anterior and middle skull base defects following tumor ablation. J Oral Maxillofac Surg 72:198–204PubMed
24.
Zurück zum Zitat Kwon D, Iloreta A, Miles B, Inman J (2017) Open anterior skull base reconstruction: a contemporary review. Semin Plast Surg 31:189–196PubMedPubMedCentral Kwon D, Iloreta A, Miles B, Inman J (2017) Open anterior skull base reconstruction: a contemporary review. Semin Plast Surg 31:189–196PubMedPubMedCentral
25.
Zurück zum Zitat Sinha UK, Johnson TE, Crocket D et al (2002) Three-layer reconstruction for large defects of the anterior skull base. Laryngoscope 112:424–427PubMed Sinha UK, Johnson TE, Crocket D et al (2002) Three-layer reconstruction for large defects of the anterior skull base. Laryngoscope 112:424–427PubMed
26.
Zurück zum Zitat Valentini V, Fabiani F, Nicolai G et al (2006) Use of microvascular free flaps in the reconstruction of the anterior and middle skull base. J Craniofac Surg 17:790–796PubMed Valentini V, Fabiani F, Nicolai G et al (2006) Use of microvascular free flaps in the reconstruction of the anterior and middle skull base. J Craniofac Surg 17:790–796PubMed
27.
Zurück zum Zitat Hanasono MM, Silva AK, Yu P, Skoracki RJ (2013) A comprehensive algorithm for oncologic maxillary reconstruction. Plast Reconstr Surg 131:47–60PubMed Hanasono MM, Silva AK, Yu P, Skoracki RJ (2013) A comprehensive algorithm for oncologic maxillary reconstruction. Plast Reconstr Surg 131:47–60PubMed
28.
Zurück zum Zitat Hanasono MM, Zevallos JP, Skoracki RJ, Yu P (2010) A prospective analysis of bony versus soft-tissue reconstruction for posterior mandibular defects. Plast Reconstr Surg 125:1413–1421PubMed Hanasono MM, Zevallos JP, Skoracki RJ, Yu P (2010) A prospective analysis of bony versus soft-tissue reconstruction for posterior mandibular defects. Plast Reconstr Surg 125:1413–1421PubMed
29.
Zurück zum Zitat Arnaoutakis D, Kadakia S, Abraham M, Lee T, Ducic Y (2017) Locoregional and microvascular free tissue reconstruction of the lateral skull base. Semin Plast Surg 31:197–202PubMedPubMedCentral Arnaoutakis D, Kadakia S, Abraham M, Lee T, Ducic Y (2017) Locoregional and microvascular free tissue reconstruction of the lateral skull base. Semin Plast Surg 31:197–202PubMedPubMedCentral
30.
Zurück zum Zitat Richmon JD, Yarlagadda BB, Wax PU, Diaz J, Lin DT (2015) Locoregional and free flap reconstruction of the lateral skull base. Head Neck 37:1387–1391PubMed Richmon JD, Yarlagadda BB, Wax PU, Diaz J, Lin DT (2015) Locoregional and free flap reconstruction of the lateral skull base. Head Neck 37:1387–1391PubMed
31.
Zurück zum Zitat Pointer DT Jr, Friedlander PL, Amedee RG, Liu PH, Chiu ES (2010) Infratemporal fossa reconstruction following total auriculectomy: an alternative flap option. J Plast Reconstr Aesthet Surg 63:e615–e618PubMed Pointer DT Jr, Friedlander PL, Amedee RG, Liu PH, Chiu ES (2010) Infratemporal fossa reconstruction following total auriculectomy: an alternative flap option. J Plast Reconstr Aesthet Surg 63:e615–e618PubMed
32.
Zurück zum Zitat Emerick KS, Herr MW, Lin DT, Santos F, Deschler DG (2014) Supraclavicular artery island flap for reconstruction of complex parotidectomy, lateral skull base, and total auriculectomy defects. JAMA Otolaryngol Head Neck Surg 140(9):861–866PubMed Emerick KS, Herr MW, Lin DT, Santos F, Deschler DG (2014) Supraclavicular artery island flap for reconstruction of complex parotidectomy, lateral skull base, and total auriculectomy defects. JAMA Otolaryngol Head Neck Surg 140(9):861–866PubMed
33.
Zurück zum Zitat Howard BE, Nagel TH, Barrs DM, Donald CB, Hayden RE (2016) Reconstruction of lateral skull base defects: a comparison of the submental flap to free and regional flaps. Otolaryngol Head Neck Surg 154:1014–1018PubMed Howard BE, Nagel TH, Barrs DM, Donald CB, Hayden RE (2016) Reconstruction of lateral skull base defects: a comparison of the submental flap to free and regional flaps. Otolaryngol Head Neck Surg 154:1014–1018PubMed
34.
Zurück zum Zitat Patel AV, Thuener JE, Clancy K, Ascha M, Manzoor NF, Zender CA (2018) Submental artery island flap versus free flap reconstruction of lateral facial soft tissue and parotidectomy defects: comparison of outcomes and patient factors. Oral Oncol 78:194–199PubMed Patel AV, Thuener JE, Clancy K, Ascha M, Manzoor NF, Zender CA (2018) Submental artery island flap versus free flap reconstruction of lateral facial soft tissue and parotidectomy defects: comparison of outcomes and patient factors. Oral Oncol 78:194–199PubMed
35.
Zurück zum Zitat Chang BA, Hall SR, Howard BE et al (2019) Submental flap for reconstruction of anterior skull base, orbital, and high facial defects. Am J Otolaryngol 40:218–223PubMed Chang BA, Hall SR, Howard BE et al (2019) Submental flap for reconstruction of anterior skull base, orbital, and high facial defects. Am J Otolaryngol 40:218–223PubMed
36.
Zurück zum Zitat Malata CM, Terhani H, Kumiponjera D, Hardy DB, Moffatt DA (2006) Use of anterolateral thigh and lateral arm fasciocutaneous free flaps in lateral skull base reconstruction. Ann Plast Surg 57:169–175PubMed Malata CM, Terhani H, Kumiponjera D, Hardy DB, Moffatt DA (2006) Use of anterolateral thigh and lateral arm fasciocutaneous free flaps in lateral skull base reconstruction. Ann Plast Surg 57:169–175PubMed
37.
Zurück zum Zitat Moncrieff MD, Hamilton SA, Lamberty GH et al (2007) Reconstructive options after temporal bone resection for squamous cell carcinoma. J Plast Reconstr Aesthet Surg 60:607–614PubMed Moncrieff MD, Hamilton SA, Lamberty GH et al (2007) Reconstructive options after temporal bone resection for squamous cell carcinoma. J Plast Reconstr Aesthet Surg 60:607–614PubMed
38.
Zurück zum Zitat Rowe D, Emmett J (2016) Reconstruction of the base of skull defect–lessons learned over 25 combined years. J Neurol Surg B 77:161–168 Rowe D, Emmett J (2016) Reconstruction of the base of skull defect–lessons learned over 25 combined years. J Neurol Surg B 77:161–168
39.
Zurück zum Zitat Patel NS, Modest MC, Brobst TD, Carlson ML, Price DL, Moore EJ, Janus JR (2015) Surgical management of lateral skull base defects. Laryngoscope 126:1911–1917PubMed Patel NS, Modest MC, Brobst TD, Carlson ML, Price DL, Moore EJ, Janus JR (2015) Surgical management of lateral skull base defects. Laryngoscope 126:1911–1917PubMed
40.
Zurück zum Zitat Disa JJ, Rodriguez VM, Cordeiro PG (1998) Reconstruction of lateral skull base oncological defects: the role of free tissue transfer. Ann Plast Surg 41:633–639PubMed Disa JJ, Rodriguez VM, Cordeiro PG (1998) Reconstruction of lateral skull base oncological defects: the role of free tissue transfer. Ann Plast Surg 41:633–639PubMed
41.
Zurück zum Zitat Rosenthal EL, King K, McGrew BM, Carroll W, Magnuson JS, Wax MK (2008) Evolution of a paradigm for free tissue transfer reconstruction of lateral temporal bone defects. Head Neck 30:589–594PubMed Rosenthal EL, King K, McGrew BM, Carroll W, Magnuson JS, Wax MK (2008) Evolution of a paradigm for free tissue transfer reconstruction of lateral temporal bone defects. Head Neck 30:589–594PubMed
42.
Zurück zum Zitat Chang DW, Langstein HN, Gupta A et al (2001) Reconstructive management of cranial base defects after tumor ablation. Plast Reconstr Surg 107:1346–1355PubMed Chang DW, Langstein HN, Gupta A et al (2001) Reconstructive management of cranial base defects after tumor ablation. Plast Reconstr Surg 107:1346–1355PubMed
43.
Zurück zum Zitat Miller JD, Taylor RJ, Ambros EC et al (2017) Complications of open approaches to the skull base in the endoscopic era. J Neurol Surg B 78:11–17 Miller JD, Taylor RJ, Ambros EC et al (2017) Complications of open approaches to the skull base in the endoscopic era. J Neurol Surg B 78:11–17
44.
Zurück zum Zitat Kim K, Ibrahim AMS, Koolen PGL, Seyidova N, Lin SJ (2015) Analysis of morbidity and mortality of patients undergoing skull base reconstruction. J Craniofac Surg 26:135–140PubMed Kim K, Ibrahim AMS, Koolen PGL, Seyidova N, Lin SJ (2015) Analysis of morbidity and mortality of patients undergoing skull base reconstruction. J Craniofac Surg 26:135–140PubMed
45.
46.
Zurück zum Zitat Thompson NJ, Roche JP, Schularick NM, Chang KE, Hansen MR (2016) Reconstruction outcomes following lateral skull base resection. Otol Neurotol 38:264–271 Thompson NJ, Roche JP, Schularick NM, Chang KE, Hansen MR (2016) Reconstruction outcomes following lateral skull base resection. Otol Neurotol 38:264–271
47.
Zurück zum Zitat Gill KS, Hsu D, Tassone P et al (2017) Postoperative cerebrospinal fluid leak after microvascular reconstruction of craniofacial defects with orbital exenteration. Laryngoscope 127:835–841PubMed Gill KS, Hsu D, Tassone P et al (2017) Postoperative cerebrospinal fluid leak after microvascular reconstruction of craniofacial defects with orbital exenteration. Laryngoscope 127:835–841PubMed
48.
Zurück zum Zitat O’Connell DA, Teng MS, Mendez E, Futran ND (2011) Microvascular free tissue transfer in the reconstruction of scalp and lateral temporal bone defects. Craniomaxillofac Trauma Reconstr 4(4):179–187PubMedPubMedCentral O’Connell DA, Teng MS, Mendez E, Futran ND (2011) Microvascular free tissue transfer in the reconstruction of scalp and lateral temporal bone defects. Craniomaxillofac Trauma Reconstr 4(4):179–187PubMedPubMedCentral
Metadaten
Titel
Reconstruction after open surgery for skull-base malignancies
verfasst von
Matthew M. Hanasono
Publikationsdatum
13.02.2020
Verlag
Springer US
Erschienen in
Journal of Neuro-Oncology / Ausgabe 3/2020
Print ISSN: 0167-594X
Elektronische ISSN: 1573-7373
DOI
https://doi.org/10.1007/s11060-019-03370-1

Weitere Artikel der Ausgabe 3/2020

Journal of Neuro-Oncology 3/2020 Zur Ausgabe

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Sozialer Aufstieg verringert Demenzgefahr

24.05.2024 Demenz Nachrichten

Ein hohes soziales Niveau ist mit die beste Versicherung gegen eine Demenz. Noch geringer ist das Demenzrisiko für Menschen, die sozial aufsteigen: Sie gewinnen fast zwei demenzfreie Lebensjahre. Umgekehrt steigt die Demenzgefahr beim sozialen Abstieg.

Hirnblutung unter DOAK und VKA ähnlich bedrohlich

17.05.2024 Direkte orale Antikoagulanzien Nachrichten

Kommt es zu einer nichttraumatischen Hirnblutung, spielt es keine große Rolle, ob die Betroffenen zuvor direkt wirksame orale Antikoagulanzien oder Marcumar bekommen haben: Die Prognose ist ähnlich schlecht.

Was nützt die Kraniektomie bei schwerer tiefer Hirnblutung?

17.05.2024 Hirnblutung Nachrichten

Eine Studie zum Nutzen der druckentlastenden Kraniektomie nach schwerer tiefer supratentorieller Hirnblutung deutet einen Nutzen der Operation an. Für überlebende Patienten ist das dennoch nur eine bedingt gute Nachricht.

Thrombektomie auch bei großen Infarkten von Vorteil

16.05.2024 Ischämischer Schlaganfall Nachrichten

Auch ein sehr ausgedehnter ischämischer Schlaganfall scheint an sich kein Grund zu sein, von einer mechanischen Thrombektomie abzusehen. Dafür spricht die LASTE-Studie, an der Patienten und Patientinnen mit einem ASPECTS von maximal 5 beteiligt waren.

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.