Chin David, Harvey Richard J
University of New South Wales, Macquarie University, St Vincent's Hospital, Sydney, Australia.
Adv Otorhinolaryngol. 2013;74:104-18. doi: 10.1159/000342285. Epub 2012 Dec 18.
Endoscopic skull base reconstruction (ESBR) is an established option for complete reconstruction of the anterior skull base (ASB). While free mucosal grafts are still relevant for limited defects (<10 mm), the evolution of vascular flaps has extended the limits of reconstruction with up to 94% success in defect closure and avoidance of cerebrospinal fluid (CSF) leak. This article discusses the planning and execution in ESBR for anterior fossa defects. Factors influencing the choice of reconstruction (flap location, size, influence of raised intracranial pressure, high flow CSF leak, radiotherapy) are examined. The reconstructive options are discussed, including the nasoseptal flap (NSF), inferior turbinate pedicled flap and the endopericranial flap, with particular emphasis on the technical aspects of reconstruction using the NSF. A step-by-step description, with an accompanying video, is provided. Techniques applicable to ESBR in general (subdural graft placement, graft/flap placement, barrier and support dressing) are covered. Novel flaps for ASB reconstruction are also briefly-described.
内镜下颅底重建术（ESBR）是一种用于完全重建前颅底（ASB）的既定方法。虽然游离黏膜移植对于有限的缺损（<10毫米）仍然适用，但血管化皮瓣的发展扩大了重建的范围，缺损闭合成功率高达94%，并避免了脑脊液（CSF）漏。本文讨论了前颅窝缺损的ESBR手术规划与实施。研究了影响重建选择的因素（皮瓣位置、大小、颅内压升高的影响、高流量脑脊液漏、放疗）。讨论了重建方案，包括鼻中隔皮瓣（NSF）、下鼻甲带蒂皮瓣和硬脑膜内皮层皮瓣，特别强调了使用NSF进行重建的技术要点。提供了分步说明及配套视频。涵盖了一般适用于ESBR的技术（硬脑膜下移植放置、移植/皮瓣放置、屏障和支撑敷料）。还简要介绍了用于ASB重建的新型皮瓣。
