Contemporary options for lateral skull base reconstruction following tumor extirpation

Abstract

This review is timely and relevant for several reasons. More lateral skull base tumors are being diagnosed, as the threshold to image patients with lower cranial nerve symptoms is very low. Patients are living longer and can potentially have more comorbidities that can affect wound healing. More surgical teams are attempting lateral skull base surgery. Patients with benign and malignant tumors of the lateral skull base may also be treated with radiotherapy and chemotherapy, which can have implications for wound healing. Abdominal fat grafting continues to be a viable option for closure of defects resulting from transtemporal skull base surgery. Hydroxyapatite cranioplasty remains controversial due to a high incidence of delayed infection. For malignant lateral skull base lesions such as advanced temporal bone and parotid malignancies, free tissue transfer is increasingly utilized, as it is reliable, is harvested outside the surgical field, and provides superior wound closure. Bone anchored hearing aids (BAHAs) can be a good option for hearing rehabilitation, whereas vistafix can reliably address auricular deformities. Proper reconstruction after tumor resection in skull base surgery is important to prevent postoperative complications. This article will address contemporary reconstruction options including primary closure, abdominal fat grafting, synthetic materials, microvascular free tissue transfer, BAHA and vistafix.