Abstract
Background
Failure of skull base reconstruction is a life-threatening issue. This study describes surgical techniques utilising various types of galeal flaps and reports on outcome of these procedures for skull base reconstruction.
Method
Clinical records of 136 patients (75 men, 61 women; mean age, 50.0 years) who required skull base reconstruction with galeal flaps were reviewed retrospectively. Patients had undergone skull base surgeries with simultaneous reconstruction for benign tumours in 77 patients, malignant tumours in 53, and other lesions in 6. We repaired dural defects using a fascial patch, and covered the skull base defects using various types of galeal flap according to the size and location of the skull base defects. Routine spinal drainage was not used in any patients.
Findings
Reconstruction was performed as planned in all patients. We utilised a galea frontalis flap in 17 patients, temporoparietal galeal flap in 95, temporoparietal galeal flap with calvarial bone in 9, and bipedicled temporoparietal galeal flap in 15. Postoperative complications included scalp wound necrosis in 8 patients (5.9%), transient leakage of cerebrospinal fluid in 3 (2.2%), and intracranial infection in 2 (1.5%). Necrosis of the galeal flaps was not encountered.
Conclusions
Galea is a well-vascularised tissue with homogenous thickness. Since the galeal layer covers the entire head area, various types of galeal flap can be elevated to cover any size and location of skull base defect.
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References
Badie B, Preston JK, Hartig GK (2000) Use of titanium mesh for reconstruction of large anterior cranial base defects. J Neurosurg 93:711–714
Clayman GL, DeMonte F, Jaffe DM, Schusterman MA, Weber RS, Miller MJ, Goepfert H (1995) Outcome and complications of extended cranial-base resection requiring microvascular free-tissue transfer. Arch Otolaryngol Head Neck Surg 121:1253–1257
Derome PJ (1988) The transbasal approach to tumors invading the base of the skull. In: Shcimidek H, Sweet WM (eds) Operative neurosurgical techniques, 2nd edn. Grune and Stratton, New York, pp 619–633
Fukuta K, Potparic Z, Sugihara T, Rachmiel A, Forte RA, Jackson IT (1994) A cadaver investigation of the blood supply of the galeal frontalis flap. Plast Reconstr Surg 94:794–800
Fukuta K, Saito K, Takahashi M, Torii S (1997) Surgical approach to midline skull base tumors with olfactory preservation. Plast Reconstr Surg 100:318–325
Hasegawa M, Torii S, Fukuta K, Saito K (1995) Reconstruction of the anterior cranial base with the galeal frontalis myofascial flap and the vascularized outer table calvarial bone graft. Neurosurgery 36:725–729, discussion 729–731
Kiyokawa K, Tai Y, Inoue Y, Tanabe HY, Hayakawa K, Mori K, Hirano M, Shigemori M, Tokutomi T (2000) Efficacy of temporal musculopericranial flap for reconstruction of the anterior base of the skull. Scand J Plast Reconstr Surg Hand Surg 34:43–53
Kiyokawa K, Tai Y, Inoue Y, Yanaga H, Mori K, Shigemori M, Tokutomi T (1999) A reconstruction method using musculopericranial flaps that prevents cerebrospinal fluid rhinorrhea and intracranial complications after extended anterior skull base resection. Skull Base Surg 9:211–219
McCutcheon IE, Blacklock JB, Weber RS, DeMonte F, Moser RP, Byers M, Goepfert H (1996) Anterior transcranial (craniofacial) resection of tumors of the paranasal sinuses: surgical technique and results. Neurosurgery 38:471–479, discussion 479–480
Neligan PC, Mulholland S, Irish J, Gullane PJ, Boyd JB, Gentili F, Brown D, Freeman J (1996) Flap selection in cranial base reconstruction. Plast Reconstr Surg 98:1159–1166, discussion 1167–1158
Nibu K, Sasaki T, Kawahara N, Sugasawa M, Nakatsuka T, Yamada A (1998) Complications of craniofacial surgery for tumors involving the anterior cranial base. Neurosurgery 42:455–461, discussion 461–452
Patel SG, Singh B, Polluri A, Bridger PG, Cantu G, Cheesman AD, deSa GM, Donald P, Fliss D, Gullane P, Janecka I, Kamata SE, Kowalski LP, Kraus DH, Levine PA, dos Santos LR, Pradhan S, Schramm V, Snyderman C, Wei WI, Shah JP (2003) Craniofacial surgery for malignant skull base tumors: report of an international collaborative study. Cancer 98:1179–1187
Saito K, Takahashi M, Fukuta K, Tachibana E, Yoshida J (1999) Recovery of olfactory function after an anterior craniofacial approach. Skull Base Surg 9:201–206
Snyderman CH, Janecka IP, Sekhar LN, Sen CN, Eibling DE (1990) Anterior cranial base reconstruction: role of galeal and pericranial flaps. Laryngoscope 100:607–614
Spetzler RF, Herman JM, Beals S, Joganic E, Milligan J (1993) Preservation of olfaction in anterior craniofacial approaches. J Neurosurg 79:48–52
Tachibana E, Saito K, Fukuta K, Yoshida J (2002) Evaluation of the healing process after dural reconstruction achieved using a free fascial graft. J Neurosurg 96:280–286
Tachibana E, Saito K, Takahashi M, Fukuta K, Yoshida J (2000) Surgical treatment of a massive chondrosarcoma in the skull base associated with Maffucci's syndrome: a case report. Surg Neurol 54:165–169, discussion 169–170
Tellioglu AT, Tekdemir I, Erdemli EA, Tuccar E, Ulusoy G (2000) Temporoparietal fascia: an anatomic and histologic reinvestigation with new potential clinical applications. Plast Reconstr Surg 105:40–45
Wormald PJ, Alun-Jones T (1991) Anatomy of the temporalis fascia. J Laryngol Otol 105:522–524
Yamamoto Y, Minakawa H, Yoshida T, Igawa H, Sugihara T, Ohura T, Nohira K (1993) Role of bone graft in reconstruction of skull base defect: is a bone graft necessary. Skull Base Surg 3:223–229
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Ito, E., Watanabe, T., Sato, T. et al. Skull base reconstruction using various types of galeal flaps. Acta Neurochir 154, 179–185 (2012). https://doi.org/10.1007/s00701-011-1174-3
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DOI: https://doi.org/10.1007/s00701-011-1174-3