Department of Neurosurgery, Tokyo Medical and Dental University.
Department of Head and Neck Surgery, Tokyo Medical and Dental University.
Neurol Med Chir (Tokyo). 2022 Oct 15;62(10):483-487. doi: 10.2176/jns-nmc.2022-0146. Epub 2022 Sep 6.
Cerebrospinal fluid (CSF) leakage is a major complication following endoscopic endonasal skull base surgery. Various skull base reconstruction methods are available, and the use of a vascularized nasoseptal flap (NSF) in skull base reconstruction has greatly contributed to a decrease in the CSF leak rate. A balloon catheter such as a sinus balloon or a Foley catheter is often used to support an NSF; however, in cases wherein nasal and/or paranasal structures supporting the balloon are lacking following the surgery, the NSF is not properly fixed and postoperative CSF leak may occur. Here we introduce a new technique of using multiple-balloon catheters to fix an NSF in such cases and provide the results of our analysis of the new technique's efficacy. Eight patients who underwent endonasal endoscopic surgery for the following cases were included: olfactory neuroblastoma (n = 6), recurrent craniofacial meningioma (n = 1), and recurrent chordoma (n = 1). After tumor resection, multilayered reconstruction with vascularized NSF was performed. Given that the Foley catheter was not stable to fix the flap in each case, we used an additional nasal catheter to support the Foley catheter. No complications such as postoperative CSF leak and necrosis of the vascularized flap were observed. These results suggest that the multiple-balloon catheter technique is a useful method for fixing the NSF to the skull base even when nasal cavity structures are missing due to surgical removal.
脑脊液（CSF）漏是内镜经鼻颅底手术的主要并发症。有多种颅底重建方法，使用血管化鼻中隔-鼻黏膜瓣（NSF）进行颅底重建极大地降低了 CSF 漏的发生率。球囊导管（如鼻窦球囊或 Foley 导管）常用于支撑 NSF；然而，在手术后鼻腔和/或鼻旁结构缺乏支撑球囊的情况下，NSF 不能得到适当固定，术后可能发生 CSF 漏。在这里，我们介绍了一种在这种情况下使用多球囊导管固定 NSF 的新技术，并提供了对新技术疗效的分析结果。我们纳入了 8 名因以下病例接受经鼻内镜手术的患者：嗅神经母细胞瘤（n = 6）、复发性颅面脑膜瘤（n = 1）和复发性脊索瘤（n = 1）。肿瘤切除后，采用血管化 NSF 进行多层重建。由于在每个病例中 Foley 导管都不稳定，无法固定皮瓣，因此我们使用了额外的鼻导管来支撑 Foley 导管。未观察到术后 CSF 漏和血管化皮瓣坏死等并发症。这些结果表明，即使由于手术切除导致鼻腔结构缺失，多球囊导管技术也是固定 NSF 到颅底的有效方法。
