Lam Kent, Luong Amber U, Yao William C, Citardi Martin J
1 Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia.
2 Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas.
Am J Rhinol Allergy. 2018 Jul;32(4):310-317. doi: 10.1177/1945892418773637. Epub 2018 May 7.
Background The use of abdominal free fat is a traditional surgical method for the repair and reconstruction of the anterior skull base. Our objective is to assess the outcomes associated with the autologous fat graft to endoscopically repair anterior skull base defects at a single tertiary care center. Methods All patients, who underwent endoscopic skull base repair utilizing abdominal free fat from September 2009 to June 2016, were included for retrospective chart review. Evaluated outcome measurements included (1) the successful closure of preoperative and intraoperative cerebrospinal fluid (CSF) leaks and (2) complications at both donor and recipient graft sites during the postoperative periods. Four representative clinical cases have additionally been selected to highlight the common indications for which the fat graft may be effective in skull base reconstruction. Results Of the 27 patients who were identified for inclusion in this review, 25 (92.6%) demonstrated successful repair of preoperative or intraoperative CSF leaks following primary skull base repair. Two patients developed recurrent CSF leaks occurring about 1 week after their primary closures, and a secondary closure rate of 96.3% was achieved with use of fat grafts. Other complications included seroma and hematoma formation at the abdominal donor sites, each occurring in 1 patient. Conclusions The use of autologous fat remains a viable option for grafting material during endoscopic skull base reconstruction. Despite the wide variety of closure techniques in skull base surgery, autologous fat provides safe and easily accessible material to repair CSF leaks.
使用腹部游离脂肪是修复和重建前颅底的传统手术方法。我们的目的是评估在单一三级医疗中心使用自体脂肪移植内镜修复前颅底缺损的效果。方法：纳入2009年9月至2016年6月期间接受利用腹部游离脂肪进行内镜下颅底修复的所有患者进行回顾性病历审查。评估的结果指标包括：（1）术前和术中脑脊液（CSF）漏的成功闭合；（2）术后供体和受体移植部位的并发症。另外选取了4个具有代表性的临床病例，以突出脂肪移植在颅底重建中可能有效的常见适应症。结果：在确定纳入本综述的27例患者中，25例（92.6%）在初次颅底修复后成功修复了术前或术中的脑脊液漏。2例患者在初次闭合后约1周出现复发性脑脊液漏，使用脂肪移植后二次闭合率达到96.3%。其他并发症包括腹部供体部位出现血清肿和血肿，各有1例患者发生。结论：在进行内镜下颅底重建时，使用自体脂肪仍然是一种可行的移植材料选择。尽管颅底手术中有各种各样的闭合技术，但自体脂肪为修复脑脊液漏提供了安全且易于获取的材料。
