Georgantopoulou A, Hodgkinson P D, Gerber C J
Northern Skull Base and Craniofacial Service, Newcastle General Hospital, Newcastle upon Tyne, UK.
Br J Plast Surg. 2003 Jan;56(1):10-3. doi: 10.1016/s0007-1226(03)00013-4.
Skull-base surgery is associated with a high risk of cerebrospinal fluid (CSF) leak, infection, and functional and aesthetic deformity. Appropriate reconstruction of cranial-base defects following surgery helps to prevent these complications. Between March 1998 and May 2000, 28 patients (age: 1-68 years) underwent reconstruction of the anterior and middle cranial fossae. The indications for surgery were tumours, trauma involving the anterior cranial fossa, midline dermoid cysts with intracranial extension, late post-traumatic CSF leak, craniofacial deformity and recurrent frontal mucocoele. We used local anteriorly based pericranial flaps (23 flaps, alone or in combination with other flaps), bipedicled galeal flaps (seven patients) and free flaps (nine patients; radial forearm fascial/fasciocutaneous flaps, rectus abdominis muscle flap and latissimus dorsi muscle flap). Follow-up has been 4-24 months. We had no deaths, no flap failure and no incidence of infection. Complications included two CSF leaks, three intracranial haematomas and one pulsatile enophthalmos. All patients had a very good aesthetic result. We present an algorithm for skull-base reconstruction and comment on the design and vascularity of the bipedicled galeal flap. The monitoring of intracranial flaps and the difficulties of perioperative management of free flaps in neurosurgical patients are also discussed.
颅底手术伴有脑脊液漏、感染以及功能和美观畸形的高风险。术后对颅底缺损进行适当重建有助于预防这些并发症。1998年3月至2000年5月，28例患者（年龄1 - 68岁）接受了前颅窝和中颅窝的重建。手术适应证包括肿瘤、累及前颅窝的创伤、伴有颅内扩展的中线皮样囊肿、创伤后晚期脑脊液漏、颅面畸形和复发性额部黏液囊肿。我们使用了局部带蒂颞肌筋膜瓣（23例，单独使用或与其他瓣联合使用）、双蒂帽状腱膜瓣（7例患者）和游离瓣（9例患者；桡侧前臂筋膜/筋膜皮瓣、腹直肌瓣和背阔肌瓣）。随访时间为4 - 24个月。我们没有死亡病例，没有皮瓣失败，也没有感染发生。并发症包括2例脑脊液漏、3例颅内血肿和1例搏动性眼球内陷。所有患者的美观效果都非常好。我们提出了一种颅底重建的算法，并对双蒂帽状腱膜瓣的设计和血供进行了评论。还讨论了颅内皮瓣的监测以及神经外科患者游离皮瓣围手术期管理的困难。
