2172 Upfront Anterolateral Thigh Free Flap Reconstruction After Posterior Fossa Skull Base Tumor Resection

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INTRODUCTION: Posterior fossa reconstruction following skull-base tumor resection has high complication rates, particularly cerebrospinal fluid (CSF) leakage. While anterolateral thigh (ALT) free-flap repair may mitigate these risks, the influence of patient and perioperative factors on outcomes is insufficiently understood. METHODS: We retrospectively reviewed six patients at high risk for wound healing complications who underwent upfront ALT free-flap reconstruction after posterior fossa tumor resection from 2018 to 2023. Data on demographics (age, BMI, smoking status), comorbidities (diabetes, coronary artery disease, COPD, CKD, prior radiotherapy), and surgical variables (indication, prior surgeries, recipient vessels, surgical approach, operative time) were recorded. Outcomes included hospital and ICU length of stay, CSF leak, pneumocephalus, pseudomeningocele, seizures, wound complications, and reoperation. RESULTS: Six patients (mean age 44 years, range 23-53) underwent tumor resection for two temporal-bone squamous cell carcinomas, a middle-fossa meningioma, a petroclival meningioma, and two vestibular schwannomas. Three had prior radiotherapy, and four had prior surgery in the area. Mean operative time was 11.9 hours (range 10.4-14.6). Various approaches were employed: an infratemporal, open lateral skull-base, combined pterional–retrosigmoid, postauricular, and two transcochlear approaches. The lateral circumflex femoral artery was anastomosed to either the facial artery or the superficial temporal artery. Postoperatively, no CSF leaks or seizures occurred. Two patients developed pneumocephalus (one with pseudomeningocele). Three experienced tumor recurrences requiring reoperation. No patients experienced flap-related complications in the perioperative or long-term follow-up period (mean: 3.3 yrs, range 1.7-6.8). CONCLUSIONS: The absence of CSF leak or other flap-related postoperative complications in our cohort aligns with existing evidence that upfront ALT free-flap reconstruction of the posterior fossa is safe and may be associated with improved surgical outcomes for high-risk patients.

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