Abstract
P056
Objectives: Classical craniofacial resection and the subcranial approach are well-established techniques for the removal of tumors involving the anterior skull base. These procedures may be further complicated by local infection and osteomyelitis of the frontal bone due to a direct communication between the osteotomy and the contaminated nasoethmoidal cavity. We present a new method for wrapping of the frontal bone segment with a pericranial flap with the intention of preventing these serious complications.
Methods: Following subcranial tumor extirpation, the frontal sinus bone is cranialized and the fronto-naso-orbital (FNO) segment is repositioned in its original anatomic position. Wrapping is accomplished by a double-sided covering of the bone segment with the pericranial flap. This vascularized tissue is guided underneath the bony segment to cover the intranasal surface and then is externalized over the entire frontal area. The FNO segment and its overlying pericranial flap are fixed with the pre-bent titanium plates.
Results: To date, we have performed 15 subcranial surgeries for resection of malignant tumors of the anterior skull base using this technique. None of these patients developed bone flap necrosis or osteomyelitis.
Conclusion: The pericranial wrapping is suitable for patients undergoing extirpation of anterior skull base tumors and for whom perioperative radiotherapy is recommended as well as for patients who have undergone multiple surgical procedures prior to the index operation. Whether pericranial wrapping decreases the rate of osteomyelitis, osteoradionecrosis, and fistula following skull base procedures awaits further study.