Pacific Neuroscience Institute, Santa Monica, CA, USA.
Pacific Neuroscience Institute, Santa Monica, CA, USA; Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA.
Clin Neurol Neurosurg. 2022 Jun;217:107266. doi: 10.1016/j.clineuro.2022.107266. Epub 2022 Apr 26.
The supraorbital eyebrow craniotomy is a minimally invasive approach that provides access to pathologies of the anterior and middle cranial fossae. Vascularized flaps are preferred when considering reconstructive options, however, small incisions may not provide adequate access to vascularized tissue. We present two cases demonstrating a modified technique for harvesting pericranium through an eyebrow supraorbital craniotomy for reconstruction of large skull base defects.
The first case is of a 62-year-old woman with an invasive esthesioneuroblastoma. Multiple resections and reconstructions, including a large frontal craniectomy and titanium mesh cranioplasty, resulted in refractory tension pneumocephalus. A supraorbital craniotomy was performed with endoscope-assisted harvesting of a pericranial flap through a coronal plane stab incision for definitive repair. The second case is a 44-year-old woman with a high-grade neuroendocrine tumor transgressing the anterior cranial fossa. Resection was achieved via combined supraorbital eyebrow craniotomy and endoscopic endonasal approach. A multilayered reconstruction including a pericranial flap from above and a nasoseptal flap from below was used to reconstruct the defect. The pericranial flap was again harvested with endoscope assistance through a coronal plane stab incision. Both cases had excellent outcomes with no post-operative cerebrospinal fluid leak.
Repair of large anterior cranial fossa defects with a vascularized pericranial flap can be performed through a supraorbital eyebrow craniotomy. Utilizing small, strategically placed transverse (coronal plane) incisions behind the hairline allows for the endoscope-assisted harvesting of a highly customized flap. This modified technique increases the flexibility of the minimally invasive supraorbital craniotomy.
眉弓上颅骨切开术是一种微创入路，可用于前颅窝和中颅窝的病变。在考虑重建选择时，首选带血管的皮瓣，但小切口可能无法提供足够的带血管组织。我们提出了两个病例，展示了一种通过眉弓上颅骨切开术采集颅骨膜的改良技术，用于重建大型颅底缺损。
第一个病例是一名 62 岁女性，患有侵袭性嗅神经母细胞瘤。多次切除和重建，包括大面积额骨切除术和钛网颅骨成形术，导致难治性张力性气颅。通过内窥镜辅助，在冠状平面刺切口中进行眉弓上颅骨切开术，采集颅骨膜皮瓣，以进行确定性修复。第二个病例是一名 44 岁女性，患有高级神经内分泌肿瘤，侵犯前颅窝。通过联合眉弓上颅骨切开术和经鼻内镜入路进行了切除。采用多层重建，包括上方的颅骨膜皮瓣和下方的鼻中隔瓣，以重建缺损。再次通过内窥镜辅助，在冠状平面刺切口中采集颅骨膜皮瓣。两个病例均获得了良好的结果，无术后脑脊液漏。
通过眉弓上颅骨切开术可以用带血管的颅骨膜皮瓣修复大型前颅窝缺损。利用位于发际线后的小而策略性的横向（冠状平面）切口，可在内窥镜辅助下采集高度定制的皮瓣。这种改良技术增加了微创眉弓上颅骨切开术的灵活性。
