Reconstruction of the anterior cranial base with the galeal frontalis myofascial flap and the vascularized outer table calvarial bone graft.

Abstract

Reconstruction of the anterior cranial base after tumor extirpation must seal off the cranial cavity from the upper respiratory tract. The key to success is to use vascularized materials for the structural support of the brain. From October 1989 to July 1992, 10 patients underwent anterior cranial base reconstruction after basicranial tumor resection; the lesions were four meningiomas and six malignant tumors of the ethmoid, maxilla, and orbit. The malignant tumors included four recurrent tumors that had been previously treated by a transfacial approach. After tumor extirpation, the resultant bony defects in the anterior cranial base, involving the orbital roof as well as the cribriform plate, ranged from 4 x 3 to 6 x 7 cm in size. The materials used in reconstruction were the galeal frontalis myofascial flap and the outer table calvarial bone flap, which is based on the temporoparietal galeal flap. Both materials are known to have rich blood supplies. These flaps make a reliable separation between the cranial cavity and the respiratory tract in three layers: the galeal frontalis myofascial flap, the vascularized calvarial bone, and the temporoparietal galea. Postoperative complications included one subcutaneous hematoma and one temporary cerebrospinal fluid rhinorrhea. We think this reconstructive technique will be useful in selected circumstances, especially after resection of a recurrent malignant tumor.