Yano Tomoyuki, Okazaki Mutsumi, Tanaka Kentarou, Iida Hideo, Aoyagi Masaru, Tsunoda Atsunobu, Kishimoto Seiji
Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
J Neurol Surg B Skull Base. 2012 Apr;73(2):125-31. doi: 10.1055/s-0032-1301402.
To classify the defects of the skull base, we present a new concept that is intuitive, simple to use, and consistent with subsequent reconstructive procedures. The centers of defects are determined in the anterior (I) or middle (II) skull base. The defects are classified as localized in the defect's center (Ia, IIa) or extended horizontally (Ib, IIb) or vertically (Ic, IIc) from the defect's center. Accompanying defects of the orbital contents and skin are indicated by "O" and "S," respectively. An algorithm for selecting subsequent reconstructive procedures was based on the classification. Using the new system, we retrospectively reclassified 90 skull base defects and examined how the defect classifications were related to the reconstructive flaps used and postoperative complications. All defects were reclassified with the new system without difficulty or omission. The mean correlation rate was high (88%) between the flaps indicated by the new classification and the flaps that had actually been used. The rate of postoperative complications tended to be higher with Ia, Ic, and IIb defects and combined defects. Our new classification concept can be used to classify defects and to help select flaps used for subsequent reconstructive procedures.
为了对颅底缺损进行分类，我们提出了一个直观、易用且与后续重建手术相一致的新概念。缺损中心位于前颅底（I）或中颅底（II）。缺损被分类为位于缺损中心（Ia、IIa），或从缺损中心水平（Ib、IIb）或垂直（Ic、IIc）扩展。眼眶内容物和皮肤的伴随缺损分别用“O”和“S”表示。基于该分类制定了选择后续重建手术的算法。使用新系统，我们对90例颅底缺损进行了回顾性重新分类，并研究了缺损分类与所使用的重建皮瓣及术后并发症之间的关系。所有缺损均能顺利地用新系统重新分类，无困难或遗漏。新分类所指示的皮瓣与实际使用的皮瓣之间的平均符合率较高（88%）。Ia、Ic和IIb类缺损及合并缺损的术后并发症发生率往往较高。我们的新分类概念可用于对缺损进行分类，并有助于选择用于后续重建手术的皮瓣。
