Secondary craniofacial problems following skull base surgery.

Skull base wounds remain the most challenging that a skull base surgeon faces because of the unique and unforgiving requirements of the intracranial compartment. To successfully reconstruct these defects after complex exposure and radical resection around vital structures, a most conservative approach must be taken (i.e., one must choose the option that has the greatest chance to be successful, even if it means taking the extra time and effort of doing a free tissue transfer). Indeed, one can take no short cuts if the skull base would be left with a tenuous repair. Close postoperative surveillance of the patient for complications and maximal medical management is essential. Because of the difficulty of examining the hidden skull base wound postoperatively, surgeons must have a low threshold for re-exploration if a complication is suspected. As the first decade of the multidisciplinary skull base team approach passes, and long-term results are being assessed, the question of "is it worth it?" is fair. The reported series are showing increased survival rates and decreased complication rates. Therefore, the answer would appear to be "yes". The question is best answered, however, by the individual patient who previously had no hope for treatment of his or her deep-seated skull base tumor.