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Skull base surgery. 1999; 9(3): 221–226.
PMCID: PMC1656732

Evaluation with Three-Dimensional Computed Tomography after Anterior Skull Base Reconstruction Using Two Musculopericranial Flaps and a Grafted Bone


Postoperative evaluation by three-dimensional (3D) computed tomography (CT) was performed in 15 patients who underwent anterior skull base reconstruction using two musculopericranial flaps and a grafted bone sandwiched between the two flaps. Especially in the case of large bone grafts (4 × 4 cm or more), the graft was positioned with the convex side facing upward into the cranial cavity to avoid creating an intracranial dead space. The extent of the absorption and changes in the contour of the grafted bone were evaluated. Imaging was done at a CT level of 150 using a Proceed 3-D CT scanner (Yokogawa Medical Co., Tokyo, Japan). Donor bone for grafting to the skull base was harvested the cranium in 10 patients and the ilium in 5 others. Patients ranged in age from 7 to 76 years (mean, 47); there were 10 men and 5 women. The grafted bone ranged in size from 1 × 2 cm to 5 × 8 cm (1 × 2 cm to about 4 × 3 cm: 10 patients; 4 × 4 to about 5 × 8 cm: 5 patients).

No marked absorption of grafted bone was seen in these 15 patients, and no brain hernia occurred. In patients with large bone grafts (4 × 4 cm to about 5 × 8 cm), a graft that had been positioned with the convex side facing upward into cranial cavity at the time of transplant was subsequently observed to be transformed into a downward convex contour of normal skull base. Fostoperative infection did not occur because of the dead space nor were there any symptom of pressure on the brain because of the upward convexity of the grafted bone.

The present reconstructive method is not only a minimum invasive but also a safe and reliable method for anterior skull base surgery.

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Selected References

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  • Marsh JL, Vannier MW. The "third" dimension in craniofacial surgery. Plast Reconstr Surg. 1983 Jun;71(6):759–767. [PubMed]
  • Cutting C, Bookstein FL, Grayson B, Fellingham L, McCarthy JG. Three-dimensional computer-assisted design of craniofacial surgical procedures: optimization and interaction with cephalometric and CT-based models. Plast Reconstr Surg. 1986 Jun;77(6):877–887. [PubMed]
  • Marsh JL, Vannier MW, Bresina S, Hemmer KM. Applications of computer graphics in craniofacial surgery. Clin Plast Surg. 1986 Jul;13(3):441–448. [PubMed]
  • Merville LC, Derome P. Concomittant dislocations of the face and skull. J Maxillofac Surg. 1978 Feb;6(1):2–14. [PubMed]
  • Tessier P, Hemmy D. Three dimensional imaging in medicine. A critique by surgeons. Scand J Plast Reconstr Surg. 1986;20(1):3–11. [PubMed]
  • Barrow DL, Nahai F, Tindall GT. The use of greater omentum vascularized free flaps for neurosurgical disorders requiring reconstruction. J Neurosurg. 1984 Feb;60(2):305–311. [PubMed]
  • Bridger GP, Baldwin M, Gonski A. Craniofacial resection for paranasal sinus cancer with free flap repair. Aust N Z J Surg. 1986 Nov;56(11):843–847. [PubMed]
  • Fukuta K, Potparic Z, Sugihara T, Rachmiel A, Forté RA, Jackson IT. A cadaver investigation of the blood supply of the galeal frontalis flap. Plast Reconstr Surg. 1994 Nov;94(6):794–800. [PubMed]
  • Har-Shai Y, Fukuta K, Collares MV, Stefanovic PD, Filipovic BR, Herschman BR, Jackson IT. The vascular anatomy of the galeal flap in the interparietal and midline regions. Plast Reconstr Surg. 1992 Jan;89(1):64–69. [PubMed]
  • Izquierdo R, Leonetti JP, Origitano TC, al-Mefty O, Anderson DE, Reichman OH. Refinements using free-tissue transfer for complex cranial base reconstruction. Plast Reconstr Surg. 1993 Sep;92(4):567–575. [PubMed]
  • Jackson IT, Adham MN, Marsh WR. Use of the galeal frontalis myofascial flap in craniofacial surgery. Plast Reconstr Surg. 1986 Jun;77(6):905–910. [PubMed]
  • Jones NF, Sekhar LN, Schramm VL. Free rectus abdominis muscle flap reconstruction of the middle and posterior cranial base. Plast Reconstr Surg. 1986 Oct;78(4):471–479. [PubMed]
  • Kaplan IB, Gilbert DA, Terzis JK. The vascularized fascia of the scalp. J Reconstr Microsurg. 1989 Jan;5(1):7–15. [PubMed]
  • Nakajima H, Imanishi N, Minabe T. The arterial anatomy of the temporal region and the vascular basis of various temporal flaps. Br J Plast Surg. 1995 Oct;48(7):439–450. [PubMed]
  • Price JC, Loury M, Carson B, Johns ME. The pericranial flap for reconstruction of anterior skull base defects. Laryngoscope. 1988 Nov;98(11):1159–1164. [PubMed]
  • Rinehart GC, Jackson IT, Potparic Z, Tan RG, Chambers PA. Management of locally aggressive sinus disease using craniofacial exposure and the galeal frontalis fascia-muscle flap. Plast Reconstr Surg. 1993 Dec;92(7):1219–1226. [PubMed]
  • Rosen HM, Simeone FA, Bruce DA. Single stage composite resection and reconstruction of malignant anterior skull base tumors. Neurosurgery. 1986 Jan;18(1):7–11. [PubMed]
  • Sasaki CT, Ariyan S, Spencer D, Buckwalter J. Pectoralis major myocutaneous reconstruction of the anterior skull base. Laryngoscope. 1985 Feb;95(2):162–166. [PubMed]
  • Schaefer SD, Close LG, Mickey BE. Axial subcutaneous scalp flaps in the reconstruction of the anterior cranial fossa. Arch Otolaryngol Head Neck Surg. 1986 Jul;112(7):745–749. [PubMed]
  • Stiernberg CM, Bailey BJ, Weiner RL, Calhoun KH, Quinn FB. Reconstruction of the anterior skull base following craniofacial resection. Arch Otolaryngol Head Neck Surg. 1987 Jul;113(7):710–712. [PubMed]
  • Snyderman CH, Janecka IP, Sekhar LN, Sen CN, Eibling DE. Anterior cranial base reconstruction: role of galeal and pericranial flaps. Laryngoscope. 1990 Jun;100(6):607–614. [PubMed]
  • Yamada A, Harii K, Ueda K, Asato H. Free rectus abdominis muscle reconstruction of the anterior skull base. Br J Plast Surg. 1992 May-Jun;45(4):302–306. [PubMed]
  • Schuller DE, Goodman JH, Miller CA. Reconstruction of the skull base. Laryngoscope. 1984 Oct;94(10):1359–1364. [PubMed]
  • Fisher J, Jackson IT. Microvascular surgery as an adjunct to craniomaxillofacial reconstruction. Br J Plast Surg. 1989 Mar;42(2):146–154. [PubMed]
  • Kaweski S, Jackson IT. Importance of separation of the nasopharyngeal and extradural spaces. Skull Base Surg. 1997;7(2):85–88. [PMC free article] [PubMed]

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