Patel Mihir R, Stadler Michael E, Snyderman Carl H, Carrau Ricardo L, Kassam Amin B, Germanwala Anand V, Gardner Paul, Zanation Adam M
Skull Base. 2010 Nov;20(6):397-404. doi: 10.1055/s-0030-1253573.
As endoscopic skull base resections have advanced, appropriate reconstruction has become paramount. The reconstructive options for the skull base include both avascular and vascular grafts. We review these and provide an algorithm for endoscopic skull base reconstruction. One hundred and sixty-six skull base dural defects, reconstructed with an endonasal vascular flap, were examined. As an adjunct, avascular reconstruction techniques are discussed to illustrate all options for endonasal skull base reconstruction. Cerebrospinal fluid (CSF) leak rates are also discussed. Small CSF leaks may be successfully repaired with various avascular grafting techniques. Endoscopic endonasal approaches (EEAs) to the skull base often have larger dural defects with high-flow CSF leaks. Success rates for some EEA procedures utilizing avascular grafts approach 90%, yet in high-flow leak situations, success rates are much lower (50 to 70%). Defect location and complexity guides vascularized flap choice. When nasoseptal flaps are unavailable, anterior/sellar defects are best managed with an endoscopically harvested pericranial flap, whereas clival/posterior defects may be reconstructed with an inferior turbinate or temporoparietal flap. An endonasal skull base reconstruction algorithm was constructed and points to increased use of various vascularized reconstructions for more complex skull base defects.
随着内镜下颅底切除术的发展，合适的重建变得至关重要。颅底的重建选择包括非血管化和血管化移植物。我们回顾这些内容并提供一种内镜下颅底重建的算法。对166例采用鼻内血管化皮瓣重建的颅底硬脑膜缺损进行了检查。作为辅助手段，还讨论了非血管化重建技术，以说明鼻内颅底重建的所有选择。还讨论了脑脊液（CSF）漏率。小的脑脊液漏可以通过各种非血管化移植技术成功修复。内镜下经鼻入路（EEA）治疗颅底疾病时，通常会出现较大的硬脑膜缺损和高流量脑脊液漏。一些采用非血管化移植物的EEA手术成功率接近90%，但在高流量漏的情况下，成功率要低得多（50%至70%）。缺损位置和复杂性指导血管化皮瓣的选择。当鼻中隔皮瓣不可用时，前/鞍区缺损最好采用内镜下采集的颅骨膜瓣处理，而斜坡/后颅窝缺损可采用下鼻甲或颞顶叶皮瓣重建。构建了一种鼻内颅底重建算法，该算法指出对于更复杂的颅底缺损，应增加使用各种血管化重建方法。
