• Samuel Vieira, Ahmed Nabil, Guillermo Maza, Mostafa Shahein, Kyle Vankoevering, Krupal B Patel, Daniel Prevedello, Ricardo Carrau, Enver Ozer, Giuliano Silveira-Bertazzo, and Thiago Albonette-Felicio.
• Department of Neurological Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA. Electronic address: samuel.vos@gmail.com.
• World Neurosurg. 2020 Jun 1; 138: 485-490.

BackgroundCraniocervical junction chordoma treated with surgery and Proton Beam Therapy evolved with Osteonecrosis and CSF leak. As the vascularization of the head was compromised, we harvested an Anterolateral thigh musculofascial flap to seal the leak.Case DescriptionA 56-year-old man presented with a history of chronic headaches and dysarthria with tongue deviation to the right. Magnetic resonance imaging showed a lesion at the craniocervical junction with imaging characteristics compatible with chordoma. Endoscopic endonasal resection was followed by proton beam therapy. Recurrence of the chordoma was subsequently resected via far lateral approach again followed by proton beam therapy accumulating a total dose of 75 Gy. Unfortunately, this led to osteoradionecrosis of the skull base resulting in a cerebrospinal fluid (CSF) leak more than 1 year after treatment. After multiple failed attempts to seal the defect using local vascularized tissue and free fat grafts, the defect was reconstructed with a vastus lateralis free tissue transfer. Six weeks later, the flap had mucosalized, the patient was pain free, and there was no evidence of a CSF leak.ConclusionsIn select cases, vascularized free flaps offer a superior reconstruction for osteoradionecrosis because radiotherapy often compromises the blood supply of local tissues.Copyright © 2020 Elsevier Inc. All rights reserved.

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