Wheless Stephan A, McKinney Kibwei A, Carrau Ricardo L, Snyderman Carl H, Kassam Amin B, Germanwala Anand V, Zanation Adam M
Skull Base. 2011 Mar;21(2):93-8. doi: 10.1055/s-0030-1266763.
The vascularized nasoseptal flap has become a principal reconstructive technique for the closure of endonasal skull base surgery defects. Despite its potential utility, there has been no report describing the use of the modern nasoseptal flap to repair traumatic cerebrospinal fluid (CSF) leaks and documenting the outcomes of this application. Specific concerns in skull base trauma include septal trauma with disruption of the flap pedicle, multiple leak sites, and issues surrounding persistent leaks after traumatic craniotomy. We performed a retrospective case series review of 14 patients who underwent nasoseptal flap closure of traumatic CSF leaks in a tertiary academic hospital. Main outcome measures include analysis of clinical outcome data. Defect etiology was motor vehicle collision in eight patients (57%), prior sinus surgery in four (29%), and assault in two (14%). At the time of nasoseptal flap repair, four patients had failed prior avascular grafts and two had previously undergone craniotomies for repair. Follow-up data were available for all patients (mean, 10 months). The overall success rate was 100% (no leaks), with 100% defect coverage. The nasoseptal flap is a versatile and reliable local reconstructive technique for ventral base traumatic defects, with a 100% CSF leak repair rate in this series.
带血管蒂鼻中隔瓣已成为鼻内镜下颅底手术缺损修复的主要重建技术。尽管其具有潜在的应用价值，但尚无报道描述使用现代鼻中隔瓣修复外伤性脑脊液（CSF）漏并记录该应用的结果。颅底创伤的具体问题包括鼻中隔创伤伴瓣蒂中断、多个漏口部位以及外伤性开颅术后持续性漏口的相关问题。我们对一家三级学术医院中14例行鼻中隔瓣修复外伤性脑脊液漏的患者进行了回顾性病例系列研究。主要结局指标包括临床结局数据分析。缺损病因包括8例（57%）机动车碰撞伤、4例（29%）既往鼻窦手术史和2例（14%）袭击伤。在进行鼻中隔瓣修复时，4例患者既往无血管移植物修复失败，2例曾接受开颅手术修复。所有患者均有随访数据（平均10个月）。总体成功率为100%（无漏液），缺损覆盖率为100%。鼻中隔瓣是修复腹侧颅底创伤性缺损的一种通用且可靠的局部重建技术，本系列中脑脊液漏修复率为100%。
