Reconstructive management of cranial base defects following tumor ablation

Purpose: To assess the impact of potential risk factors on rates of complications and patient survival, and to identify reconstructive management principles for achieving successful cranial base reconstruction. Methods: Seventy-seven cranial base reconstructions performed by the Department of Plastic Surgery at our institution between January 1993 and September 1999 were reviewed. Results: Reconstructive methods included free flaps in 52 (68%), temporalis muscle flaps in 14 (18%), and other local flaps (e.g. pericranial) in 11 patients (14%). Complications occurred in 21 patients (27%). Overall survival was 77% at 2 years and 58% at 4 years. The type of reconstruction, location of defect, type of durai repair, and history of preoperative radiation and chemotherapy had no significant association with the incidence of complications. Neither the type of reconstruction nor the location of defect showed a significant affect on patient survival. Conclusion: Local flaps, such as pericranial or temporalis muscle flaps, are good choices for reconstruction of smaller anterior or lateral cranial base defects. For large or complex defects, free flaps are appropriate. With proper patient selection, successful cranial base reconstruction can be performed with either local or free flaps with a low incidence of complications.