Guidelines for Complications of Cancer Treatment Vol VIII Part B

PreventionThe main principle to prevent CSF leakage after skull baseresection is to create an anatomical and functional seal betweenintracranial and extracranial contents bya) water-tight dural closure either primarily or by use of afree patch graftsa. pericranial patchb. fascia latac. synthetic grafts are best avoided unless absolutelynecessary.b) Use of vascularised pericranial graft to reinforce the duralclosure, if required.The vascularized pericranial flap is the workhorse foranterior skull base reconstruction. It derives its supplyfrom the supraorbital and supratrochlear arteries. Theflap is passed below and beyond the dural suture lineand fixed to the dura or the bone of the skull base. If theorbital roofs are intact, then the pericranial flap may besufficient to support the brain without bonyreconstruction. Autologous or synthetic tissue glue maybe used to reinforce the closure and promote a watertightseal.In some cases with a large postoperative cavity, the deadspace has to be occluded to prevent infection and toprovide support to the overlying brain. This may be donebyi) local Temporalis muscle flap: medial transpositionof temporalis muscle is an effective way ofconstructing anterolateral skull base defects. Careshould be taken to preserve its attachment to thecoronoid process to preserve its blood supply. Itmay be used with a part of cortical bone attached246