Srinivasa Rakshith, Chandrakiran C, Luckose Rini
Department of Neurosurgery, M S Ramaiah Memorial Hospital, Bangalore, Karnataka, India.
Department of Ear Nose and Throat, M S Ramaiah Medical College and Hospital, Bangalore, Karnataka, India.
Neurol India. 2021 Mar-Apr;69(2):307-310. doi: 10.4103/0028-3886.314538.
The success of endoscopic skull base surgery is largely based on the effective repair of the skull base defect. A pedicled nasoseptal flap (NSF), described by Hadad-Bassagateguy is the workhorse of contemporary endoscopic skull base repair. We describe a modification in the technique, "double breasting technique," using the bilateral posterior NSF for skull base repair.
In this video article, we describe the technique of harvesting bilateral posterior nasal septal flaps and overlaying the flaps in a double breasting technique to cover the skull base defect. The posterior NSF can be used to cover medium to large skull base defects effectively.
A 40-year-old female patient presented with headache and decreased vision for 2 months. MRI with gadolinium showed a sellar suprasellar lesion with chiasmal compression. Visual field charting showed bitemporal hemianopia. She underwent endoscopic transnasal transsphenoidal surgery (binostril approach) and complete excision of tumor. Intraoperatively, there was evidence of arachnoid breach with high flow cerebrospinal fluid (CSF) leak. Sella was repaired with fat, fascia, fibrin glue, and overlaid with the bilateral posterior NSF in a double breasting technique, as described in the video.
The skull base repair was successful, with no CSF leak postoperatively.
内镜颅底手术的成功很大程度上基于颅底缺损的有效修复。哈达德 - 巴萨加泰古描述的带蒂鼻中隔瓣（NSF）是当代内镜颅底修复的主要手段。我们描述了一种技术改良，即“双乳技术”，使用双侧后鼻中隔瓣进行颅底修复。
在这篇视频文章中，我们描述了获取双侧后鼻中隔瓣并以双乳技术覆盖这些瓣以修复颅底缺损的技术。后鼻中隔瓣可有效用于覆盖中至大型颅底缺损。
一名40岁女性患者出现头痛和视力下降2个月。钆增强MRI显示鞍上病变伴视交叉受压。视野检查显示双颞侧偏盲。她接受了内镜经鼻经蝶窦手术（双侧鼻孔入路）并完整切除肿瘤。术中，有蛛网膜破裂伴高流量脑脊液（CSF）漏的证据。如视频中所述，用脂肪、筋膜、纤维蛋白胶修复蝶鞍，并以双乳技术覆盖双侧后鼻中隔瓣。
颅底修复成功，术后无脑脊液漏。
