Al-Asousi Fahad, Okpaleke Christopher, Dadgostar Anali, Javer Amin
Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, St. Paul's Sinus Centre, University of British Columbia, Vancouver, British Columbia, Canada.
Am J Rhinol Allergy. 2017 Mar 1;31(2):122-126. doi: 10.2500/ajra.2017.31.4411.
Many reconstructive techniques and materials have been reported for repair of skull base defects after sinonasal tumor excision, cerebrospinal fluid (CSF) leaks, and coverage of denuded bone. Synthetic materials have been developed for endoscopic skull base repair to avoid donor-site morbidity. Polydioxanone plate is a bioabsorbable implant designed for nasal septal reconstruction and has the ability to retain strength for at least 10 weeks and absorbs in 6 months.
This study aimed to describe the use of polydioxanone plates in endoscopic skull base defect and CSF leak repair, and to describe our experience with the surgical technique and postoperative management.
This was a retrospective case series of patients who, between May 2013 and December 2015, underwent endoscopic sinus surgery and skull base repair for CSF leak or after excision of a skull base tumor by using polydioxanone plates. Patients who presented with sinonasal inflammatory disease or skull base tumors underwent endoscopic skull base repair by using polydioxanone plates in an underlay fashion and mucosal membrane grafts with or without adjuvant materials in an overlay fashion. The patients were reviewed at 6 days, 6 weeks, and 3 months after surgery. Postoperative adverse events, including CSF leak, infection, bleeding, headache, and graft failure, were recorded.
The cases of seven patients (five women, two men; mean age, 53.9 years) were reviewed. Five patients underwent sinonasal tumor resection and two underwent repair for CSF leak. The mean (standard deviation) defect size was 16.4 ± 11.4 mm. There was no evidence of postoperative CSF leak, and lumbar drains were not used. One patient reported transient headache and facial pressure at the 6-week follow-up visit. The surgeons' experience with polydioxanone plate placement, postoperative healing, and follow-up was satisfactory.
Polydioxanone could be used to achieve rigid repair of endoscopic skull base defects. These early results, although promising, require validation in clinical trials.
已有许多重建技术和材料用于修复鼻窦肿瘤切除术后的颅底缺损、脑脊液（CSF）漏以及覆盖裸露的骨质。已开发出合成材料用于内镜下颅底修复，以避免供区并发症。聚二氧六环酮板是一种用于鼻中隔重建的生物可吸收植入物，能够保持强度至少10周，并在6个月内吸收。
本研究旨在描述聚二氧六环酮板在内镜下颅底缺损和脑脊液漏修复中的应用，并介绍我们在手术技术和术后管理方面的经验。
这是一项回顾性病例系列研究，研究对象为2013年5月至2015年12月期间因脑脊液漏或颅底肿瘤切除术后使用聚二氧六环酮板接受内镜鼻窦手术和颅底修复的患者。患有鼻窦炎性疾病或颅底肿瘤的患者采用聚二氧六环酮板进行衬里修复，并采用带或不带辅助材料的黏膜移植物进行覆盖修复。在术后6天、6周和3个月对患者进行复查。记录术后不良事件，包括脑脊液漏、感染、出血、头痛和移植物失败。
对7例患者（5例女性，2例男性；平均年龄53.9岁）的病例进行了回顾。5例患者接受了鼻窦肿瘤切除术，2例患者接受了脑脊液漏修复术。平均（标准差）缺损大小为16.4±11.4mm。没有术后脑脊液漏的证据，也未使用腰大池引流。1例患者在6周随访时报告有短暂头痛和面部压迫感。外科医生在聚二氧六环酮板植入、术后愈合和随访方面的经验令人满意。
聚二氧六环酮可用于实现内镜下颅底缺损的坚固修复。这些早期结果虽然很有前景，但需要在临床试验中得到验证。
