Department of Otolaryngology - Head & Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Neurosurgery. 2012 Dec;71(2 Suppl Operative):ons219-25; discussion ons225-6. doi: 10.1227/NEU.0b013e3182684ac8.
Although rare, recalcitrant cerebrospinal fluid (CSF) leak after skull base tumor resection or major head trauma is a difficult therapeutic challenge, often complicated by lack of local vascularized tissue in a scarred, radiated field. Craniotomy with a free tissue transfer has been described for CSF leak repair from these complicated skull base defects.
: We present our experience with a novel extracranial approach to manage refractory CSF leaks with a radial forearm free flap set in through a transantral and ethmoid sinus approach.
Five patients with recalcitrant CSF leaks in the anterior skull base underwent radial forearm free tissue transfer via a hybrid transantral-endoscopic approach.
There were 4 female patients and 1 male patient. Average age was 58 years (range, 30-72 years). Four patients had previous neurosurgical anterior skull base tumor resections, and 1 patient had significant head trauma leading to a recalcitrant CSF leak. All 5 patients had undergone multiple prior endoscopic and/or open repairs. All 5 patients had successful resolution of their leak after undergoing radial forearm free tissue transfer. Two of 5 patients required a second minor endoscopic procedure. No patients required a craniotomy.
An extracranial transantral-endoscopic approach for the inset of radial forearm free flap is a safe treatment technique that precludes the need for a craniotomy and promotes effective repair of CSF leaks refractory to traditional endoscopic procedures.
RFFF, radial forearm free flap.
颅底肿瘤切除或严重头部创伤后顽固的脑脊液（CSF）漏是一种治疗难题，尽管罕见，但由于瘢痕、放射性区域缺乏局部血管化组织，往往使治疗更为复杂。对于这些复杂的颅底缺损导致的 CSF 漏，开颅术结合游离组织转移已被用于修复 CSF 漏。
我们介绍了一种通过经蝶窦和筛窦入路应用游离前臂桡侧皮瓣修复难治性前颅底 CSF 漏的新型颅外方法。
5 例前颅底难治性 CSF 漏患者采用混合经蝶窦内镜入路行游离前臂桡侧皮瓣转移术。
4 例女性，1 例男性，平均年龄 58 岁（范围 30-72 岁）。4 例患者有前颅底神经外科肿瘤切除术史，1 例患者有严重头部创伤导致难治性 CSF 漏。所有 5 例患者均经历过多次内镜和/或开放修复。所有 5 例患者均在接受游离前臂桡侧皮瓣转移后成功解决了漏液问题。5 例中有 2 例需要进行第二次小的内镜手术。无患者需要开颅手术。
经颅外蝶窦内镜入路内置游离前臂桡侧皮瓣是一种安全的治疗技术，可避免开颅手术，并促进对传统内镜手术难治性 CSF 漏的有效修复。
RFFF，游离前臂桡侧皮瓣。
