Reconstruction of ablative skull base defects in the pediatric population

BACKGROUND: Neoplasms of the skull base are rare in children and require a multidisciplinary approach. Surgical defects are often large and cause significant functional, aesthetic, and psychological issues. The authors present their experience with reconstruction of the anterior and lateral skull base in the pediatric population. METHODS: The authors conducted a retrospective review at a comprehensive cancer center. RESULTS: Between January of 1993 and February of 2005, 10 children and adolescents underwent surgical resection of a skull base tumor followed by reconstruction of the skull base. Patients ranged in age from 6.4 to 17.9 years (median, 11.8 years). Four patients had rhabdomyosarcoma, and one each had spindle cell sarcoma, chondrosarcoma, liposarcoma, malignant fibrous histiocytoma, mucoepidermoid carcinoma, and neurofibromatosis. Surgical defects involved the anterior skull base in three patients, the infratemporal fossa in three patients, both the anterior and middle cranial fossae in three patients, and the temporal bone in one patient. Fourteen flap procedures were performed in these patients-11 after tumor resection and three in a delayed fashion to promote improved functional and aesthetic outcomes. Complications occurred in three patients, and there was one case of flap loss. CONCLUSIONS: Skull base reconstruction may be reliably and successfully accomplished in children and adolescents using soft-tissue free flaps or regional flaps. Full rehabilitation, including bony reconstruction and prosthetic rehabilitation, may be accomplished as craniofacial development plateaus in adolescence.