Nagm Alhusain, Ogiwara Toshihiro, Hongo Kazuhiro
Department of Neurosurgery, Shinshu University School of Medicine.
Department of Neurosurgery, Faculty of Medicine, Al-Azhar University.
Neurol Med Chir (Tokyo). 2019 Mar 15;59(3):79-88. doi: 10.2176/nmc.oa.2018-0262. Epub 2019 Feb 21.
Endoscopic skull base reconstruction (ESBR) following expanded-endoscopic endonasal approaches (EEA) in high-risk non-ideal endoscopic reconstructive candidates remains extremely challenging, and further innovations are still necessary. Here, the aim is to study the reconstructive knowledge gap following expanded-EEA and to introduce the watertight robust osteoconductive (WRO)-barrier as an alternative durable option. Distinctively, we focused on 10 clinical circumstances. A 3D-skull base-water system model was innovated to investigate the ESBR under realistic conditions. A large-irregular defect (31 × 89 mm) extending from the crista galli to the mid-clivus was achieved. Then, WRO-barrier was fashioned and its tolerance was evaluated under stressful settings, including an exceedingly high (55 cmHO) pressure, with radiological assessment. Next, the whole WRO-barrier was drilled to examine its practical-safe removal (simulating redo-EEA) and the whole experiment was repeated. Finally, WRO-barrier was kept into place to value its 18-month long-term high-tolerance. Results in all experiments of WRO-barriers were satisfactorily fashioned to conform the geometry of the created defect under realistic circumstances via EEA, tolerated an exceedingly high pressure without evidence of leak even under stressful settings, resisted sudden-elevated pressure, and remained in its position to maintain long-term watertight seal (18 months), efficiently evaluated with neuroimaging and simply removed-and-reconstructed when redo-EEA is needed. In conclusion, WRO-barrier as an osteoconductive watertight robust design for cranial base reconstruction possesses several distinct qualities that might be beneficial for patients with complex skull base tumours.
对于高风险、非理想的内镜重建候选患者，在扩大经鼻内镜入路（EEA）后进行内镜颅底重建（ESBR）仍然极具挑战性，仍需进一步创新。在此，目的是研究扩大EEA后的重建知识差距，并引入水密性强的骨传导（WRO）屏障作为一种耐用的替代选择。特别地，我们聚焦于10种临床情况。创新了一种三维颅底水系统模型，以在现实条件下研究ESBR。制造出一个从鸡冠延伸至斜坡中部的大的不规则缺损（31×89毫米）。然后，制作WRO屏障，并在包括极高（55厘米水柱）压力的应激环境下评估其耐受性，并进行影像学评估。接下来，对整个WRO屏障进行钻孔，以检查其实际安全取出情况（模拟再次EEA），并重复整个实验。最后，将WRO屏障放置到位，评估其18个月的长期高耐受性。WRO屏障在所有实验中的结果均令人满意，能够在现实情况下通过EEA贴合所制造缺损的几何形状，即使在应激环境下也能耐受极高压力且无渗漏迹象，能抵抗压力突然升高，并保持在位以维持长期水密密封（18个月），通过神经影像学可有效评估，并且在需要再次EEA时可简单取出并重建。总之，WRO屏障作为一种用于颅底重建的骨传导水密性强的设计，具有若干独特特性，可能对复杂颅底肿瘤患者有益。
