Sandwich-like reconstruction of anterior skull base defects

RESULTS From October, 1984 to October, 1998, 116 patientsunderwent transcranial or transcranial-facial approach forthe resection of malignant or benign aggressive tumor, andsandwich-like repairs were performed for the anterior skullbase defect. Fifty-four (46.6%) patients had previous ope-ration, with a maximum of 5 surgeries. The average age ofpatients was 35.9 years old,ranging from 6 to 73 years old.Forty-eight (41.4%) Patients had malignant neoplasmas, in-

Sandwich-like Reconstruction of Anterior Skull Base Defects

Objective:To evaluate the safety and efficacy of new modality of anterior skull base repair,namely sandwich-like reconstruction of anterior skull base defects. Methods : A retrospective analysis of patients who underwent wanscranial or wanscranial-facial resections of malignant or benign aggressive tumors involving the anterior skull base was conducted in our department. We used the sandwich-like reconstruction, using pedicled pericranial flap, frontal muscle flap and free abdominal adipose tissue between them, to separate of cranial cavity and aerodigest tract and keep the frontal lobes in place following resections of anterior skull base tumors. Results: From October, 1984 to October, 1998, 116 patients underwent tmnscranial or tmnscranial-facial approach for the resection of malignant or aggressive benign tumor, and sandwich-like repairs were performed for the anterior skull base defect.54 (46.6%) patients had previous operation, with a maximum of 5 surgeries. The average age of patients was 35.9 years old, ranging form 6 to 73 years old. Forty-eight (41.4%) patients had malignant neoplasmas, and sixty-eight (58.6%) patients had benign aggressive tumors. In our series, with the maximal follow-ups for as long as 14 years, NO one had early failure of the one-stage reconstruction. CSF fluid leakage was not encountered, nor was ascending bacterial meningitis observed. No immediate or delayed prolapse of dura or frontal lobes was observed. Conclusion: We conclude that the sandwich-like reconstruction, using pericranial flap, frontal muscle flap and free abdominal adipose between them, is an extremely safe and effective procedure for the repair of skull base defect, even when tumor extensively involves anterior skull base.

Effect of cefazolin loaded bone matrix gelatin on repairing large segmental bone defects and preventing infection

Objective: To explore the possibility of repairi ng long segmental bone defects and preventing infection with cefazolin loaded bo ne matrix gelatin (C-BMG).Methods: C-BMG was made from putting cefazolin into BMG by vac uum absorption and lyophilization techniques. The sustaining period of effective drug concentration in vitro and in vivo was detected. The time of inhibiting ba cteria,and the drug concentration in local tissues (bone and muscle) and plasma after implantation of C-BMG were examined by high performance liquid chromatog raphy. Results: The effective inhibition time to staphylococcus aureus of C-BMG was 22 days in vitro; while 14 days in vivo. The cefazolin concentrat ion in local tissues was higher in early stage,and later it kept a stable and l ow drug release. C-BMG showed an excellent ability to repair segmental long bon e defects.Conclusions: C-BMG can gradually release cefazolin with effect ive drug concentration and has excellent ability to repair segmental bone defect s. It can be used to repair segmental long bone defects and prevent infection af ter operation.