Complications of resection of malignant tumours of the skull base: outcome and solution

The results of surgical resection of malignant tumours located at the skull base have improved significantly over the years. There are however still some complications associated with these procedures. For central skull base lesions, the anterolateral approach exposes the region adequately for an oncological resection to be carried out. The development of palatal fistula in irradiated patient has been a nuisance. With modification of the palatal incision, this problem is now eliminated. For the management of osteoradronecrosis of the skull base, an uncommon late complication, a microvascular free muscle flap is required. For malignant pathologies located at the anterior skull base, a combined craniofacial resection is the treatment of choice. Our experience as well as those reported in the literature showed that when the skull base defect was small, the pericranial and the galeofrontalis flap were adequate for reconstruction. For larger defects, a microvascular free flap would be used. When the internal carotid artery is included in the resection, an extracranial-intracranial arterial bypass should be created before the resection of tumour. The most serious complication is the development of cerebral spinal fluid leakage. Conservative treatment is applicable for small leakage while for large leakage; the exact location of the leak must be identified before the defect can be closed successfully.