Microvascular reconstruction of cranial base defects: An evaluation of complication and survival rates to justify the use of this repair.

OBJECTIVES To describe our experience, including selection criteria and complication rates, using microvascular free tissue transfer to repair large skull base defects and to determine if complication rate and posttreatment survival justify the use of this technique. DESIGN Retrospective review of clinical cohort. SETTING Tertiary care medical center. PATIENTS A consecutive sample of patients undergoing ablative surgery with repair of cranial base defects with free tissue transfer from 1995 to 2004. All the patients' defects involved intracranial exposure. MAIN OUTCOME MEASURES Rate of local and systemic complications, postoperative survival, and recurrence rate. RESULTS The study population comprised 40 patients. Fifteen (38%) of the patients' defects were in the anterior cranial base, and 26 (65%) were in the middle cranial base. We used 5 types of free tissue flap, with a success rate of 95%. Our rate of perioperative mortality, meningitis, stroke, cerebrospinal fluid leak, epidural abscess, and osteomyelitis was 0%. We had 7 local complications and 4 systemic complications requiring increased length of hospital stay. Including microvascular problems, 12 patients had complications, for an overall complication rate of 30%. Follow-up ranged from 1 to 96 months, with a mean of 24 months. The tumor recurrence rate was 30%, and disease-specific survival was 81% at a mean 24-month follow-up. CONCLUSIONS We did not experience any perioperative mortality or intracranial morbidity. Our low complication rate in combination with our tumor recurrence rate and rate of patient survival justify the use of free tissue transfer as an option in the closure of appropriate cranial base defects.