Shi Justin, Ayeni Tokunbo, Gallagher Kathleen Kelly, Patel Akash J, Jalali Ali, Hernandez David J, Haskins Angela D, Sandulache Vlad C, Sturgis Erich M, Huang Andrew T
Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States.
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States.
J Neurol Surg B Skull Base. 2021 Feb 22;83(4):359-366. doi: 10.1055/s-0041-1722899. eCollection 2022 Aug.
Standardized reconstruction protocols for large open anterior skull base defects with dural resection are not well described. Here we report the outcomes and technique of a multilayered reconstructive algorithm utilizing local tissue, dural graft matrix, and microvascular free tissue transfer (MVFTT) for reconstruction of these deformities. This study is a retrospective review. Eleven patients (82% males) met inclusion criteria, with five (45%) having concurrent orbital exenteration and eight (73%) requiring maxillectomy. All patients required dural resection with or without intracranial tumor resection, with the average dural defect being 36.0 ± 25.9 cm . Dural graft matrices and pericranial flaps were used for primary reconstruction of the dural defects, which were then reinforced with free fascia or muscle overlay by means of MVFTT. Eight (73%) patients underwent anterolateral thigh MVFTT, with the radial forearm, fibula, and vastus lateralis comprising the remainder. Average total surgical time of tumor resection and reconstruction was 14.9 ± 3.8 hours, with median length of hospitalization being 10 days (IQR: 9.5, 14). Continuous cerebrospinal fluid drainage through a lumber drain was utilized in 10 (91%) patients perioperatively, with an average length of indwelling drain of 5 days. Postoperative complications occurred in two (18%) patients who developed asymptomatic pneumocephalus that resolved with high-flow oxygen therapy. A standardized multilayered closure technique of dural graft matrix, pericranial flap, and MVFTT overlay in the reconstruction of large open anterior craniofacial dural defects can assist the reconstructive team in approaching these complex deformities and may help prevent postoperative complications.
对于伴有硬脑膜切除的大型开放性前颅底缺损，标准化的重建方案尚无详尽描述。在此，我们报告一种多层重建算法的结果及技术，该算法利用局部组织、硬脑膜移植基质和微血管游离组织移植（MVFTT）来修复这些缺损。 本研究为回顾性分析。 11例患者（82%为男性）符合纳入标准，其中5例（45%）同时行眶内容物剜除术，8例（73%）需要行上颌骨切除术。所有患者均需行硬脑膜切除，伴或不伴颅内肿瘤切除，平均硬脑膜缺损为36.0±25.9平方厘米。硬脑膜移植基质和帽状腱膜瓣用于硬脑膜缺损的一期修复，然后通过MVFTT用游离筋膜或肌肉覆盖进行加强。8例（73%）患者接受了股前外侧MVFTT，其余患者采用桡侧前臂、腓骨和股外侧肌。肿瘤切除和重建的平均总手术时间为14.9±3.8小时，中位住院时间为10天（四分位间距：9.5，14）。10例（91%）患者围手术期通过腰大池引流持续进行脑脊液引流，平均引流留置时间为5天。2例（18%）患者出现无症状气颅，经高流量氧疗后缓解，发生了术后并发症。 在大型开放性颅面硬脑膜缺损的重建中，采用硬脑膜移植基质、帽状腱膜瓣和MVFTT覆盖的标准化多层闭合技术可帮助重建团队处理这些复杂缺损，并可能有助于预防术后并发症。
