Division of Otolaryngology and Head-Neck Surgery, Department of Surgery, Albany Medical Center, Albany, New York.
Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota.
Oper Neurosurg (Hagerstown). 2019 Jan 1;16(1):37-44. doi: 10.1093/ons/opy075.
The nasoseptal flap is the main pedicled flap used for endoscopic cranial base reconstruction. For large anterior cranial base defects, the anterior edge is a concern for the nasoseptal flap reach.
To present a surgical technique that completely releases the vascular pedicle of the nasoseptal flap from the sphenopalatine artery (SPA) foramen improving considerably the reach of the flap.
A patient with left anterior cranial base fracture involving the posterior table of the frontal sinus, who presented with cerebrospinal fluid leak and contused brain herniation to the ethmoid and frontal sinuses. Unilateral endoscopic endonasal anterior cranial base reconstruction was performed with left sided nasoseptal flap. The nasoseptal flap pedicle was dissected and completely released from the SPA foramen. The flap was left attached only to the internal maxillary artery (IMAX) vascular bundle.
The flap covered the entire left anterior cranial base, from the planum sphenoidale to the posterior table of the frontal sinus. There was complete obliteration of the cerebrospinal fluid fistula postoperatively with resolution of the radiographic pneumocephalus and the patient's rhinorrhea.
The complete release of the nasoseptal flap pedicle from the SPA foramen is feasible and remarkably improves the reach of the flap. It also increases the reconstructive area of the flap since the entire septal mucosa can be used for reconstruction and the pedicle length is based exclusively upon the SPA/IMAX.
鼻中隔黏膜瓣是内镜颅底重建中常用的主要带蒂皮瓣。对于较大的前颅底缺损,鼻中隔黏膜瓣的前缘到达是一个关注点。
介绍一种手术技术,即完全释放鼻中隔黏膜瓣的血管蒂(从蝶腭动脉(SPA)孔),以显著提高皮瓣的可达性。
一名患者因左前颅底骨折累及额窦后壁,出现脑脊液漏和额窦和筛窦脑挫裂伤。采用单侧内镜鼻内颅前底重建,使用左侧鼻中隔黏膜瓣。分离并完全释放鼻中隔黏膜瓣的蒂从 SPA 孔。瓣仅与上颌内动脉(IMAX)血管束相连。
该瓣覆盖了整个左前颅底,从蝶骨平台到额窦后壁。术后脑脊液瘘完全闭塞,放射学上的气颅和患者的鼻漏也得到了缓解。
完全释放鼻中隔黏膜瓣的 SPA 孔蒂是可行的,并且显著提高了皮瓣的可达性。它还增加了皮瓣的重建面积,因为整个鼻中隔黏膜都可以用于重建,并且蒂的长度完全基于 SPA/IMAX。