Department of Otolaryngology-Head and Neck Surgery, Cho Ray Hospital, District 5, Ho Chi Minh City, Vietnam.
Department of Foundation Science, Nova Southeastern University, The Kiran C. Patel College of Osteopathic Medicine (NSU-KPCOM), Clearwater, FL.
J Craniofac Surg. 2023;34(2):611-615. doi: 10.1097/SCS.0000000000008976. Epub 2022 Aug 30.
The use of surgical resection for large anterior skull base (ASB) tumors and sinonasal malignancies with intracranial extension will result in a large skull base defect. Reconstruction of large ASB defects using traditional techniques is high risk and may lead to postoperative cerebral spinal fluid (CSF) leakage, meningitis, and an increase in mortality rate. The use of a pedicled double flap technique to reconstruct the ASB defect may decrease complications. This study presents the clinical outcomes of patients who underwent double flap reconstruction techniques after resection of their sinonasal malignancies with significant intracranial extension at Cho Ray hospital in Vietnam.
The case series study was conducted at Cho Ray hospital from September 2010 to September 2020. All patients with large sinonasal malignancies that invaded intracranially underwent transnasal endoscopic surgery and subfrontal craniotomy. Reconstruction of large skull base defects (>2 cm) were followed up by using the pedicled double flaps technique. This study was performed in line with the principles of the Declaration of Helsinki. Approval of the study was granted by the Independent Ethics Committee of Cho Ray Hospital (Date: March 3, 2014/No: 11/BVCRHĐĐĐ).
During September 2010 to September 2020, there were 75 patients who underwent a modified multilayer, double flap reconstruction technique after the resection of their ASB tumor. Skull base defects were commonly seen along the horizontal plate of the ethmoid bone and the ethmoid roof (98.6%). Large skull base defects (>2 cm) accounted for 81.3% of cases. Overall, the risk of postoperative CSF leakage and meningitis after double flap repair was considerably low. Of all participants, only 1 experienced postoperative CSF leakage and 1 experienced postoperative meningitis. Despite the complications, these patients improved significantly and remained stable.
The use of double vascularized pedicled flaps may decrease the incidence of postoperative CSF leakage and meningitis. This technique is an effective method for the reconstruction of ASB tumors with large defects.
对于大型前颅底（ASB）肿瘤和鼻旁窦恶性肿瘤伴颅内延伸的患者，外科切除后会导致较大的颅底缺损。使用传统技术重建大型 ASB 缺损风险较高，可能导致术后脑脊液（CSF）漏、脑膜炎和死亡率增加。使用带蒂双瓣技术重建 ASB 缺损可减少并发症。本研究介绍了越南顺化 Cho Ray 医院在切除有明显颅内延伸的鼻旁窦恶性肿瘤后，采用双瓣重建技术的患者的临床结果。
该病例系列研究于 2010 年 9 月至 2020 年 9 月在 Cho Ray 医院进行。所有大型鼻旁窦恶性肿瘤侵犯颅内的患者均接受经鼻内镜手术和额下入路开颅术。使用带蒂双瓣技术对大颅底缺损（>2cm）进行随访。本研究符合《赫尔辛基宣言》的原则。Cho Ray 医院独立伦理委员会于 2014 年 3 月 3 日批准了该研究（日期：2014 年 3 月 3 日，编号：11/BVCRHĐĐĐ）。
2010 年 9 月至 2020 年 9 月，共有 75 例患者在切除 ASB 肿瘤后采用改良多层、双瓣重建技术。颅底缺损常见于筛骨水平板和筛骨顶（98.6%）。大颅底缺损（>2cm）占 81.3%。总体而言，双瓣修复术后 CSF 漏和脑膜炎的风险较低。所有参与者中，仅有 1 例发生术后 CSF 漏，1 例发生术后脑膜炎。尽管有并发症，但这些患者明显改善并保持稳定。
使用双血管蒂瓣可降低术后 CSF 漏和脑膜炎的发生率。该技术是治疗大缺损 ASB 肿瘤的有效方法。
