Vascularized Flaps versus Free Grafts in Endoscopic Reconstruction of Large Skull Base Defects

Background: The last decades have witnessed remarkable progress in the field of endoscopic skull base surgery. The nose has become an established route for addressing different skull base lesions. The reconstruction after resection is a critical step for optimum surgical outcome. Objective: Evaluation of the difference in the clinical outcomes between the use of vascularized flaps and free grafts in endoscopic reconstruction of large skull base defects as regards CSF leak and intracranial infections. Methods: Twenty patients who underwent endoscopic skull base reconstruction for large skull base defects (more than 1cm) between May 2013 and January 2016 were divided into two groups, treated by vascularized flaps and free grafts and followed for six months for two outcomes; CSF leak and intracranial infection. Results: The use of vascularized local flaps showed more effective separation of the nasal cavity from the cranium as regard CSF rhinorrhea (0% leak in the flap group and 20% in the graft group) and meningitis (0% in the flap group and 10% in the graft group). Conclusion: Endoscopic skull base reconstruction for large skull base defects is more efficiently done by vascularized flaps as a safe and reliable method for separation of the cranium from the nose.