Daraei Pedram, Oyesiku Nelson M, Patel Zara M
Emory University School of Medicine, Atlanta, GA.
Int Forum Allergy Rhinol. 2014 Nov;4(11):937-43. doi: 10.1002/alr.21369. Epub 2014 Sep 15.
Skull base reconstruction can be accomplished using various donor sites. Vascularized tissue, commonly the nasoseptal flap, is the most effective option for large defects or high flow leaks. In cases where the septum cannot be used, a mucoperiosteal flap from the nasal floor, pedicled from the sphenopalatine artery, is a viable option without reported outcomes. The aim of this work was to describe this flap and to report successful outcomes in a cohort of patients.
Retrospective chart review of patients seen by the senior author from 2011 to 2013 requiring skull base reconstruction for defects with cerebrospinal fluid leak.
A total of 108 patients underwent endoscopic skull base reconstruction. Ten patients had reconstruction with use of a pedicled nasal floor flap. Mean age was 53.3 years. Defects involved the ethmoid roof in 5 patients, sellar floor in 2, clivus in 2, and planum sphenoidale in 1. Reasons why the septal flap could not be used were intentional sacrifice due to disease involvement, sacrifice for proper exposure, or previous septal perforation. Mean length of follow-up was 10.2 (range, 4 to 25) months. No patient developed cerebrospinal fluid leaks postoperatively.
Nasal floor pedicled flaps are an effective alternative to nasoseptal flaps for reconstruction of the skull base, and have not been previously described in the literature. Outcomes are promising in our small cohort of patients. If the septum must be sacrificed, attention should be paid to the nasal floor, which provides a large mucoperiosteal flap that can be consistently exposed and elevated by the experienced surgeon.
颅底重建可通过多种供区来完成。带血管组织，通常是鼻中隔瓣，是修复大的缺损或高流量漏的最有效选择。在无法使用鼻中隔的情况下，来自鼻底的带蒂于蝶腭动脉的粘骨膜瓣是一种可行的选择，但尚无相关报道的结果。本研究的目的是描述这种瓣并报告一组患者的成功治疗结果。
对资深作者在2011年至2013年期间诊治的因脑脊液漏导致颅底缺损而需要进行颅底重建的患者进行回顾性病历审查。
共有108例患者接受了内镜下颅底重建。10例患者使用带蒂鼻底瓣进行了重建。平均年龄为53.3岁。缺损累及筛窦顶壁5例，鞍底2例，斜坡2例，蝶骨平台1例。无法使用鼻中隔瓣的原因包括因疾病累及而有意牺牲、为充分暴露而牺牲或既往鼻中隔穿孔。平均随访时间为10.2（范围4至25）个月。术后无患者发生脑脊液漏。
鼻底带蒂瓣是鼻中隔瓣用于颅底重建的有效替代方法，此前文献中未见描述。在我们这一小群患者中，治疗结果令人满意。如果必须牺牲鼻中隔，应关注鼻底，它可提供一块大的粘骨膜瓣，经验丰富的外科医生能够持续暴露并掀起该瓣。
