Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea.
Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, Seongnam, Republic of Korea.
J Otolaryngol Head Neck Surg. 2020 Sep 21;49(1):67. doi: 10.1186/s40463-020-00460-3.
Pedicled nasoseptal flap (PNSF) has significantly improved the surgical outcomes of endoscopic endonasal approach (EEAs) by reducing cerebrospinal fluid (CSF) leakage. The purpose of this study is to assess the feasibility of using a PNSF for anterior skull base (ASB) reconstruction and to describe a method to compensate for a short flap based on our results.
In this cadaveric study, ASB dissection without sphenoidotomy was performed using 10 formalin-fixed and 5 fresh adult cadaver specimens, and the sufficiency of the PNSF to cover the ASB was assessed. After the sphenoidotomy, the length by which the PNSF fell short in providing coverage at the posterior wall of the frontal sinus (CPFS), and the extent of the anterior coverage from the limbus (CL) of the sphenoid bone was measured.
Without sphenoidotomy, the mean length of the remaining PNSF after the coverage of the posterior wall of the frontal sinus was 0.67 cm. After sphenoidotomy, the PNSF fell short by a mean length of 2.10 cm, in providing CPFS. The CL was 1.86 cm. Based on these findings, defects resulting from an endoscopic resection of ASB tumors were reconstructed using PNSF without total sphenoidotomy in 3 patients. There were no postoperative CSF leaks or complications.
The use of PNSF for ASB reconstruction may be insufficient to cover the entire ASB defect after removal of large lesions which need total sphenoidotomy. When possible, by leaving some portion of the anterior sphenoid wall for supporting the PNSF, successful ASB reconstruction could be achieved in endoscopic resection of ASB tumors. Additional methods might be needed in some cases of large ASB lesions wherein the anterior sphenoid wall should be removed totally and the ASB defect is too large.
带蒂鼻中隔鼻瓣（Pedicled nasoseptal flap，PNSF）通过减少脑脊液（CSF）漏出，显著改善了内镜经鼻入路（endoscopic endonasal approach，EEA）的手术效果。本研究旨在评估 PNSF 在前颅底（anterior skull base，ASB）重建中的可行性，并根据我们的结果描述一种补偿短瓣的方法。
在这项尸体研究中，我们对 10 例福尔马林固定和 5 例新鲜成人尸体标本进行了 ASB 解剖，不进行蝶窦切开术，并评估了 PNSF 覆盖 ASB 的充分性。在进行蝶窦切开术之后，测量 PNSF 在覆盖额窦后壁（posterior wall of the frontal sinus，CPFS）时所短少的长度，以及从蝶骨翼突（limbus of the sphenoid bone，CL）前缘的覆盖范围。
在不进行蝶窦切开术的情况下，覆盖额窦后壁后剩余 PNSF 的平均长度为 0.67cm。在进行蝶窦切开术之后，PNSF 在 CPFS 处的覆盖长度平均短少 2.10cm，CL 为 1.86cm。基于这些发现，我们在 3 例接受内镜切除 ASB 肿瘤的患者中，在不进行全蝶窦切开术的情况下，使用 PNSF 重建了 ASB 缺损。术后均无 CSF 漏或并发症。
在切除需要全蝶窦切开术的大病变后，PNSF 用于 ASB 重建可能不足以覆盖整个 ASB 缺损。在可能的情况下，通过保留部分前蝶骨壁来支撑 PNSF，可在 ASB 肿瘤的内镜切除中成功重建 ASB。在某些情况下，需要采用其他方法，比如需要完全切除前蝶骨壁且 ASB 缺损过大的大型 ASB 病变。
