Division of Neurosurgery, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
Division of Neurosurgery, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
World Neurosurg. 2019 Aug;128:506-513. doi: 10.1016/j.wneu.2019.05.136. Epub 2019 May 24.
To describe a novel bilaterally pedicled pericranial flap for anterior cranial base reconstruction after removal of complex frontobasal cancers extending to the frontal region, thus precluding the use of standard reconstructive techniques.
In selected oncologic cranial base surgeries, the use of the standard galea frontalis pericranial flap for reconstructive purposes may be precluded by tumor infiltration. In such cases, dura mater reconstruction and exclusion of frontal sinuses from the intracranial space can be performed using a large superficial temporal artery bilaterally pedicled pericranial flap obtained from both temporoparietal regions. Surgical technique, indication, contraindication, complications, and degree of resection are recorded to evaluate the efficacy of this surgical method.
A 48-year-old man affected by a recurrence of frontobasal squamous cell carcinoma was surgically treated by combined transcranial and endoscopic endonasal resection. A large pericranial flap pedicled bilaterally on the parietal branches of the superficial temporal artery was obtained, transposed anteriorly, carefully watertight sutured to the dural defect, and used to exclude cranialized frontal sinuses as well. The reconstruction was successful, and the patient was discharged home on the tenth postoperative day without any complications and/or development of cerebrospinal fluid leak. Contrast-enhanced magnetic resonance imaging 3 months after surgery was clear from disease with consolidated surgical outcomes.
This novel pericranial flap seems to be easily obtained and effective for anterior cranial base reconstruction when the use of a traditional galea frontalis flap is precluded for oncologic reasons and there are concerns for the possible development of contaminations and cerebrospinal fluid leaks.
描述一种新颖的双侧带蒂颅骨膜瓣,用于重建复杂的额眶底部癌症切除后的颅前底,这些癌症已扩展到额区,从而排除了标准重建技术的使用。
在选定的颅底肿瘤手术中,由于肿瘤浸润,标准的额骨颅骨膜瓣可能不适合用于重建目的。在这种情况下,可以使用从颞顶区域双侧获得的大的双侧带蒂颞浅动脉颅骨膜瓣进行硬脑膜重建,并将额窦从颅内空间中排除。记录手术技术、适应证、禁忌证、并发症和切除程度,以评估该手术方法的疗效。
一名 48 岁的男性患有额眶底部鳞状细胞癌复发,通过联合经颅和经鼻内镜切除术进行了手术治疗。获得了一个大的颅骨膜瓣,双侧带蒂于颞浅动脉的顶支,向前转位,仔细严密缝合硬脑膜缺损,并用于排除颅化的额窦。重建成功,患者在术后第 10 天出院,无任何并发症和/或脑脊液漏的发生。术后 3 个月的增强磁共振成像显示疾病清除,手术结果得到巩固。
当由于肿瘤原因而排除使用传统的额骨瓣,并且存在污染和脑脊液漏的可能时,这种新颖的颅骨膜瓣似乎易于获得,并且对于颅前底重建是有效的。