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Abstract
Aim: The aim of the study was to evaluate the role of titanium mesh used in combination with other synthetic materials in providing a rigid support for reconstruction of anterior skull base defect and preventing CSF leak. Material and methods: All Cases of complex benign anterior skull base lesions operated between December 2008 and December 2013 (5 years) which had titanium mesh for reconstruction were reviewed. Six operations were performed on five patients for large anterior skull base meningioma (3 cases) and fibrous dysplasia (2 cases). The main complaint was exophthalamous in 4 patients, and one presented with nasal blockage due to ethmoidal and nasal invasion. The reconstructions were performed by using titanium mesh with pericranial flaps, synthetic dural grafts, and surgical glue. Routine lumbar drain was not used. Three patients had previous surgeries. Three patients were female, and the age range was 4 to 55. We had a minimum of 12 months follow up. The incidence of CSF leak, infections, and other surgical morbidity related to the reconstruction were recorded. The status of exophthalamous post operatively was also observed. Results: We had no incidence of CSF leak or infection. One case of recurrent psuedomeningocele was encountered and it required repeated aspiration, then lumbar drain, and finally insertion of subgalial-peritoneal shunt. Exophthalamous improved in 3 patients and remain the same in one. Conclusion: Use of titanium mesh with local flaps or synthetic dural graft and surgical glue is safe, simple, and effective for reconstruction of anterior skull base defects caused by benign tumor or fibrous dysplasia.
Highlights
Reconstruction of anterior cranial base defects is often necessary following resection of tumors, destructive infectious lesions, fibrous dysplasia, and severe trauma
Use of titanium mesh with local flaps or synthetic dural graft and surgical glue is safe, simple, and effective for reconstruction of anterior skull base defects caused by benign tumor or fibrous dysplasia
Primary intraosseous meningioma is a term used to describe a subset of extradural meningiomas that arise in bone
Summary
Reconstruction of anterior cranial base defects is often necessary following resection of tumors, destructive infectious lesions, fibrous dysplasia, and severe trauma. The aim of reconstruction is to provide a watertight barrier between intra-cranial contents, para-nasal sinuses, and orbital cavities. No CSF leak, or herniation of the brain tissue into the para-nasal sinuses or the orbits should be encountered [1]. Muscle, and fascia have been used in patients who do not have sufficient local soft tissue [3]. Synthetic materials such as dural grafts or surgical glue are currently used to provide a watertight sealant; it can be used alone or with others [4]
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