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FR.08.06
An algorithm of microvascular frontal skullbase reconstruction
Kartik G. Krishnan1 , Gabriele Schackert2 , Peter A. Winkler3 , Volker Seifert1 Departments of Neurosurgery, 1Johann Wolfgang Goethe University, Frankfurt and 2Carl Gustav
Carus University, Dresden, 3Schön Klinik, Vogtareuth
Introduction: The usage of vascularized flaps in the treatment of non-healing wounds is well known .
Certain neurosurgical nosoligies could be viewed as ‘internal’ wound healing problems . Recurrent CSFrhinorrhea
due to frontobasal disintegrity is one of those unyielding ‘internal’ wound-healing problems .
Bringing vascularized tissue to this non-healing wound bed is a possible solution for the treatment of such
difficult cases . The closure of morphological frontobasal disintegrity may be treated by local, regional and
free microvascular tissue . Our objective is to present a series of neurosurgical cases where microvascular
tissue transfer found successful application .
Methods: Among 84 patients undergoing frontal skullbase reconstruction, we treated 6 patients with recurrent
frontobasal CSF leakage using the free microvascular tissue transfer technique . All these patients
were operated several times using conventional methods . In two of the six patients the recurrent intractable
frontobasal disintegrity was a result of cranio-cerebral trauma (Gunshot wound and Automobile accident) .
One patient incurred this problem after initial decompression of the optic nerve due to Cruzon’s craniosynostosis
. In the rest the cause was encroaching skullbase tumors . In all patients the bilateral subfrontal,
intradural approach to the anterior skullbase was employed . In the first two patients free- microvascular
latissimus dorsi muscle flap and omentum were used for lining the frontal base . In the other patients we
used a free vascularized fascia-lata muscle . The choice of the flap was based on the form and extent of
the defects .
Results: None of the cases developed further recurrences of frontal skullbase disintegrity or CSF leaks
during a follow-up of 6 years of more .
Conclusion: Vascularized tissue has better and long lasting mechanical properties and are resistant to
bacterial invasion in comparison to their non-vascularized analogues . In the neurosurgical practice one
may keep the option of free vascularized tissue transfer open in difficult unyielding ‘internal’ wound healing
problems as described here . An algorithm of surgical frontal base reconstruction was evolved .
FR.09.01
Aktuelles Management komplexer Schädelbasismeningeom
Volker Seifert
Klinik und Poliklinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
58 59