Skull-base reconstruction [Neurosurgery Wiki]

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====== Skull-base reconstruction ======

[[Complication]]s after skull-base [[reconstruction]] is often problematic.

Nakamura et al. considered that local factors, for example, localization of defect areas are possible risk factors. A study aimed to investigate the [[case series]] of skull-base reconstructions and to identify local [[risk factor]]s that predispose to [[wound]] complications.

This study is presented as a [[retrospective study]]. 

Research work was taking place at Nagoya University Hospital. 

Forty-eight patients who had undergone [[reconstruction]] after mid anterior skull-base resection between January 2004 and December 2015 were included in this study. Defects apart from the skull-base were categorized into the nasal and paranasal cavity (N), orbit (O), palate (P), and facial skin (S). Postoperative local complications including cerebrospinal fluid (CSF) leakage, local infection, wound dehiscence (fistula in face or palate), and flap necrosis (partial or total) were investigated. 

The main outcome measures were postoperative complications in patients with each defect. Results  Apart from the skull-base, defects included 28 ONP (58.3%), 10 ONPS (20.8%), 3 ON (6.3%), 3 ONS (6.3%), 1 NP (2.1%), and 1 OS (2.1%). Comparison based on numbers of resected regions revealed that a significantly higher complication rate was seen in patients with four resected regions than in those with three regions (90.0% vs. 45.2%, p  < 0.05). 

There was a trend suggesting that more resected regions corresponded to a greater risk of complications in mid anterior skull-base reconstruction. Reconstructive surgeons need to carefully consider the reconstruction of such complicated defects
((Nakamura R, Takanari K, Nakamura Y, Kambe M, Hishida M, Ebisawa K, Fujimoto Y,
Fujii M, Kamei Y. Increased Defect Size is Associated with Increased Complication
Rate after Free Tissue Transfer for Midanterior Skull-Base Reconstruction. J
Neurol Surg B Skull Base. 2020 Apr;81(2):121-127. doi: 10.1055/s-0038-1676777.
Epub 2019 Feb 26. Erratum in: J Neurol Surg B Skull Base. 2020 Apr;81(2):e1.
PubMed PMID: 32206529; PubMed Central PMCID: PMC7082168.)).

see [[Endoscopic skull base reconstruction]]