Jyotirmay Hegde, Saxena Sunil Kumar, Ramesh A S, Nagarajan K, Bhat Shreshta
Assistant Professor, Department of Ear, Nose and Throat, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
Professor and Head, Department of Ear, Nose and Throat, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
J Clin Diagn Res. 2017 Jun;11(6):MC01-MC03. doi: 10.7860/JCDR/2017/26737.10118. Epub 2017 Jun 1.
The Expanded Endonasal Approaches (EEAs) have been widely used for various skull base lesions. The reconstruction of the skull base defects is of vital importance to prevent postoperative complications. The vascular pedicled-nasoseptal flap (Hadad-Bassagasteguy flap) is used as a workhorse in reconstruction of majority of the defects.
The purpose of this study was: (a) To assess the postoperative MRI appearance of vascularised pedicled nasoseptal flap for its viability; (b) To determine the variations in MRI that may suggest potential flap failure.
A prospective study of 13 patients was done, who underwent endoscopic skull base surgery with reconstruction using the Hadad-Bassagasteguy flap. Pre-operative MRI was done to assess the size, extent and location of the lesion and a postoperative MRI was done to evaluate flap configuration, enhancement patterns, location, flap thickness and signal intensity characteristics.
The postoperative MRI of all patients showed a detectable flap covering over the skull base defects forming an "open cup" appearance. They were uniformly isointense on T1-weighted/ fat suppressed images to the adjacent nasal mucosa and hyperintense on T2-weighted images. On the MRI scans done after four weeks, all 13 of our patients had enhancing flaps. One flap migrated slightly to the left side; however, there was no Cerebrospinal Fluid (CSF) leak.
Vascular pedicle nasoseptal (Hadad) flaps are being widely used. MRI is a very useful tool in assessing the viability of the flap postoperatively and to evaluate for variations that may suggest potential flap failure.
扩大经鼻入路（EEAs）已广泛应用于各种颅底病变。颅底缺损的重建对于预防术后并发症至关重要。带血管蒂鼻中隔瓣（哈达德 - 巴萨加斯特盖瓣）是大多数缺损重建中的主要手段。
本研究的目的是：（a）评估带血管蒂鼻中隔瓣术后MRI表现以判断其存活情况；（b）确定MRI上可能提示瓣潜在失败的变化。
对13例患者进行了前瞻性研究，这些患者接受了使用哈达德 - 巴萨加斯特盖瓣进行重建的内镜颅底手术。术前进行MRI以评估病变的大小、范围和位置，术后进行MRI以评估瓣的形态、强化模式、位置、瓣厚度和信号强度特征。
所有患者的术后MRI均显示可检测到的瓣覆盖在颅底缺损上，形成“开口杯”外观。在T1加权/脂肪抑制图像上，它们与相邻鼻黏膜均匀等信号，在T2加权图像上呈高信号。在四周后进行的MRI扫描中，我们的13例患者的瓣均有强化。一个瓣轻微向左移位；然而，没有脑脊液（CSF）漏。
带血管蒂鼻中隔（哈达德）瓣正在被广泛使用。MRI是评估瓣术后存活情况以及评估可能提示瓣潜在失败的变化的非常有用的工具。
