Pinheiro-Neto Carlos Diogenes, Prevedello Daniel M, Carrau Ricardo L, Snyderman Carl H, Mintz Arlan, Gardner Paul, Kassam Amin
Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
Laryngoscope. 2007 Sep;117(9):1560-9. doi: 10.1097/MLG.0b013e31806db514.
Reconstruction of the skull base after an expanded endonasal approach (EEA) is critical to achieve a good outcome. A novel technique based on the use of a pedicled nasoseptal flap has proven to be a reliable and versatile reconstructive option for extensive defects of the skull base. Data regarding the potential dimensions of a nasoseptal flap are lacking in the literature. This pilot study was developed to help optimize the design of the nasoseptal flap and to ensure that when harvesting the flap, its width and length are adequate to reconstruct the defects that are created by various EEAs.
We analyzed the computed tomographic (CT) scans of four patients who underwent EEAs for skull base lesions. Sagittal and coronal CT reconstructions were generated from axial images. The measurements were divided into skull base measurements, flap dimensions required to cover skull base defects resulting from various EEAs, and potential maximal dimensions of the nasoseptal flap. Measurements were studied for three different EEAs: sellar/transplanar, transclival, and transcribiform/anterior skull base. We measured the potential defects for each of these EEAs and the nasoseptal flap dimensions that would be required to reconstruct them. We estimated all dimensions based on the most extensive defect that could result with each EEA. We then compared these with various modifications of the nasoseptal flap.
Two male and two female patients were studied. Twenty-seven measurements were taken to compare the different skull base defects and nasoseptal flaps.
The length of the nasal septum comprises sufficient mucoperichondrium and mucoperiosteum to allow the harvesting of a nasoseptal flap that could cover any defect resulting from an anterior skull base, a transsellar/transplanar, or a transclival EEA. Similarly, the height of the nasal septum has the potential to yield a nasoseptal flap with a width that is adequate to cover the laterolateral aspect of any defect of the anterior skull base and clivus. Skull base defects resulting from combined EEAs, such as those that would create a defect that comprises the skull base from sella turcica to frontal sinus, are beyond the potential dimensions of a single nasoseptal flap. This and other defects resulting from a combination of EEAs require other strategies, such as the use of bilateral nasoseptal flaps, or the use of other reconstructive options.
扩大经鼻入路（EEA）术后的颅底重建对于取得良好疗效至关重要。一种基于带蒂鼻中隔瓣的新技术已被证明是颅底广泛缺损可靠且通用的重建选择。文献中缺乏关于鼻中隔瓣潜在尺寸的数据。开展这项初步研究是为了帮助优化鼻中隔瓣的设计，并确保在切取该瓣时，其宽度和长度足以重建由各种EEA造成的缺损。
我们分析了4例因颅底病变接受EEA的患者的计算机断层扫描（CT）图像。从轴位图像生成矢状位和冠状位CT重建图像。测量分为颅底测量、覆盖各种EEA导致的颅底缺损所需的瓣尺寸以及鼻中隔瓣的潜在最大尺寸。针对三种不同的EEA进行测量研究：鞍区/经平面、经斜坡和经筛板/前颅底。我们测量了每种EEA的潜在缺损以及重建这些缺损所需的鼻中隔瓣尺寸。我们根据每种EEA可能导致的最广泛缺损来估计所有尺寸。然后将这些尺寸与鼻中隔瓣的各种改良情况进行比较。
研究了2例男性和2例女性患者。进行了27次测量以比较不同的颅底缺损和鼻中隔瓣。
鼻中隔的长度包含足够的黏膜软骨膜和黏膜骨膜，能够切取可覆盖前颅底、经鞍区/经平面或经斜坡EEA造成的任何缺损的鼻中隔瓣。同样，鼻中隔的高度有可能产生宽度足以覆盖前颅底和斜坡任何缺损外侧部分的鼻中隔瓣。联合EEA导致的颅底缺损，例如那些会造成从蝶鞍到额窦的颅底缺损，超出了单个鼻中隔瓣的潜在尺寸范围。这种以及联合EEA导致的其他缺损需要其他策略，例如使用双侧鼻中隔瓣或其他重建选择。
