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Microsurgical Reconstruction Of Skull Base Oncologic Defects: A 23-year Institutional Experience
Daniel Soroudi, BA1, Matthew McLaughlin, BA
1, Siyou Song, MD
1, Justin Cheng, MD
1, Solomon Lee, MD
2, William Y. Hoffman, MD
1, Esther A. Kim, MD
1.
1UCSF, San Francisco, CA, USA,
2Seattle Children's Hospital, Seattle, WA, USA.
PURPOSE: This study reviews our institution's experience with microsurgical flap reconstruction for skull base reconstruction, aiming to provide clinical insights to improve decision-making and patient outcomes.
METHODS: A retrospective review was conducted on patients who underwent microsurgical reconstruction of skull base defects at a single institution from 1996 to 2019. Statistical analyses were performed to identify factors associated with complications and reoperations. Specifically, we analyzed patient demographics, flap selection, recipient vessel choices, postoperative outcomes, complications, and factors associated with reoperation.
RESULTS: : Eighty-three reconstructions were performed in 81 patients (mean age 55.8±17.5 years). Flaps included rectus abdominis (56.6%), radial forearm (15.7%), anterolateral thigh (ALT) (15.7%), latissimus dorsi (9.6%), fibula (1.2%), and osteocutaneous radial forearm (1.2%). Superficial temporal vessels were the most common recipients. Flap success rate was 96.4%. The overall complication rate was 32.5%, with the most common being infection (13.3%, including one case of meningitis), wound dehiscence (8.4%), and CSF leak (4.8%). Age and ALT flap were independent predictors of complication.
CONCLUSION: Our experience reinforces the importance of tailored flap selection and vigilant perioperative management to reduce morbidity and optimize outcomes. Despite an overall high complication rate, of note was the rarity of CSF leaks and only a single case of meningitis. While most reconstructions can be reliably achieved with well-established flap options, certain flaps may carry higher risks and should be used selectively. These findings underscore the value of microsurgical reconstruction to ensure long-term reconstructive success in skull base surgery.
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