-Case Reports-

Second Free Flap Surgery for Skull Base Tumors: Case Report and Literature Review

Asami Kubota¹, Yasuo Murai¹, Hiroki Umezawa², Eitaro Ishisaka¹, Atsushi Tsukiyama¹, Shunsuke Nakagawa¹, Fumihiro Matano¹, Rei Ogawa² and Akio Morita¹

¹Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
²Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan

Tumors of the skull base, such as meningiomas, tend to recur. With progress in free vascularized flap surgery, an increasing number of studies are investigating skull base reconstruction with free flaps after tumor removal. In this report, we discuss the results of second free flap surgery after skull base reconstructive surgery. We retrospectively analyzed data from patients treated at our center during the period from 2013 through 2017. All four patients identified had skull base anaplastic meningioma and had undergone radiotherapy. In all cases, the flap and donor blood vessel were sourced from sites that differed from those used in the previous surgeries. No complications developed, such as cerebrospinal fluid leakage, meningitis, wound infection, wound hemorrhage, or flap necrosis. Because the first flap was found to be unviable, it was difficult to preserve and was removed. Essential points in preventing complications are anchoring at the appropriate site, pinprick testing of the created flap, and use of multilayered countermeasures to prevent cerebrospinal fluid leakage.

J Nippon Med Sch 2019; 86: 248-253

Keywords
meningioma, skull base, free flap, cerebrospinal fluid, reconstruction surgery

Correspondence to
Yasuo Murai, MD, Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
ymurai@nms.ac.jp

Received, December 14, 2018
Accepted, March 2, 2019