Département de neurochirurgie, Hôpital Gui-de-Chauliac, Centre hospitalier universitaire de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
Département d'otorhinolaryngologie, Hôpital Gui-de-Chauliac, Centre hospitalier universitaire de Montpellier, Montpellier, France.
Neurochirurgie. 2021 Nov;67(6):606-610. doi: 10.1016/j.neuchi.2021.03.009. Epub 2021 Mar 23.
The reconstruction of anterior skull base defects after carcinologic surgery is challenging. Large defects can require the use of autologous free tissue transfer. Currently, most reconstructions use soft-tissue flaps. We describe the use of an osteocutaneous radial forearm free flap to reconstruct a large defect secondary to a malignant paraganglioma extending into the anterior cranial fossa and both orbits. The surgical resection required endonasal and transcranial approaches. We reconstructed the defect with a free osteocutaneous radial forearm flap. We laid the bone flap across the defect, resting on the orbital roof on each side, and sutured the soft component to the edge of the dura. The pedicle was funnelled from the craniotomy to a prepared cervicotomy and the micro-anastomoses were performed onto the facial artery and two satellite veins. Potential indications and major drawbacks of this technique are briefly discussed. Osteocutaneous radial forearm free flaps can be a valuable reconstructive option for patients with a large defect of the anterior skull base, needing both rigid support and a watertight closure.
颅底前区肿瘤术后的重建颇具挑战，大的缺损可能需要应用游离组织移植。目前，大多数重建术采用软组织皮瓣。我们描述了应用游离桡骨骨皮瓣重建颅前窝和两个眼眶内恶性副神经节瘤扩展所致的大缺损。手术切除需要经鼻内镜和颅内外联合入路。我们用游离桡骨骨皮瓣重建缺损。我们将骨瓣横跨缺损放置，两侧搁置在眶顶，将皮瓣的柔软部分缝合到硬脑膜边缘。蒂部从颅切开术处转移到预先准备好的颈部切开术，并将微血管吻合到面动脉和两个卫星静脉上。简要讨论了该技术的潜在适应证和主要缺点。游离桡骨骨皮瓣可为颅前底大缺损、需要坚固支撑和防水密闭的患者提供一种有价值的重建选择。
