Department of Neurosurgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do, South Korea.
College of Medicine, Kangwon National University, Chuncheon, South Korea.
BMC Surg. 2022 Apr 29;22(1):151. doi: 10.1186/s12893-022-01590-3.
Cerebrospinal fluid (CSF) leakage is one of the major complications after endoscopic endonasal surgery. The reconstructive nasoseptal flap is widely used to repair CSF leakage. However, it could not be utilized in all cases; thus, there was a need for an alternative. We developed a pericranial rescue flap that could cover both sellar and anterior skull base defects via the endonasal approach. A modified surgical technique that did not violate the frontal sinus and cause cosmetic problems was designed using the pericranial rescue flap.
We performed 12 cadaveric dissections to investigate the applicability of the lateral pericranial rescue flap. An incision was made, extending from the middle to the lateral part of the eyebrow. The pericranium layer was dissected away from the galea layer, from the supraorbital region towards the frontoparietal region. With endoscopic assistance, the periosteal flap was raised, the flap base was the pericranium layer at the eyebrow incision. After a burr-hole was made in the supraorbital bone, the pericranial flap was inserted via the intradural or extradural pathway.
The mean size of the pericranial flap was 11.5 cm × 3.2 cm. It was large enough to cross the midline and cover the dural defects of the anterior skull base, including the sellar region.
We demonstrated a modified endoscopic technique to repair the anterior skull base defects. This minimally invasive pericranial flap may resolve neurosurgical complications, such as CSF leakage.
脑脊液（CSF）漏是内镜鼻内手术后的主要并发症之一。重建鼻中隔瓣广泛用于修复 CSF 漏。然而，并非所有情况下都可以使用它；因此，需要一种替代方法。我们开发了一种颅盖筋膜救援瓣，可以通过经鼻内镜入路覆盖鞍区和前颅底缺损。我们使用颅盖筋膜救援瓣设计了一种改良的手术技术，该技术不侵犯额窦并引起美容问题。
我们进行了 12 例尸体解剖，以研究外侧颅盖筋膜救援瓣的适用性。切口从眉毛的中间延伸到外侧。将颅盖层从帽状腱膜层剥离，从眶上区域向额顶区域剥离。在内镜辅助下，提起骨膜瓣，瓣基为眉毛切口处的颅盖层。在眶上骨上钻一个骨孔后，通过硬脑膜内或硬脑膜外途径插入颅盖筋膜瓣。
颅盖筋膜瓣的平均大小为 11.5cm×3.2cm。它足够大，可以跨越中线并覆盖前颅底的硬脑膜缺损，包括鞍区。
我们展示了一种改良的内镜技术来修复前颅底缺损。这种微创的颅盖筋膜瓣可能解决神经外科并发症，如 CSF 漏。
