Intracranial Free Tissue Transfer for Massive Cerebrospinal Fluid Leaks of the Anterior Cranial Fossa

PurposeThe management of large skull base defects with refractory cerebrospinal fluid (CSF) leaks treated with intracranially placed free tissue transfers was examined.Materials and MethodsA retrospective review of all cases of CSF leak presenting to the senior author from 1997 to 2008 in a private tertiary care referral practice was performed. Patients with intracranially placed free flaps were specifically examined for this review.ResultsIn total 109 patients with skull base defects larger than 4 cm2 or intractable CSF leaks were identified. Eighty-eight patients underwent reconstruction with local tissue flaps or free tissue grafts. Persistent massive leaks were repaired with 11 intracranial free tissue transfers. CSF fistulas were successfully closed in each instance, with no cases of flap failure or major complications.ConclusionsIntracranial placement of nonskin-bearing free tissue is an excellent treatment alternative for massive CSF leaks and refractory CSF fistulas related to large skull base defects.