Ryan John F, Tanavde Ved A, Gallia Gary L, Boahene Kofi D O, London Nyall R, Desai Shaun C
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Am J Otolaryngol. 2023 Mar-Apr;44(2):103700. doi: 10.1016/j.amjoto.2022.103700. Epub 2022 Nov 28.
Defects resulting from open resection of anterior skull base neoplasms are difficult to reconstruct. Our objective was to review the literature and describe an evidence-based algorithm that can guide surgeons reconstructing anterior skull base defects.
A research librarian designed database search strategies. Two investigators independently reviewed the resulting abstracts and full text articles. Studies on reconstruction after open anterior skull base resection were included. Studies of lateral and posterior skull base reconstruction, endoscopic endonasal surgery, traumatic and congenital reconstruction were excluded. Based on the review, a reconstructive algorithm was proposed.
The search strategy identified 603 unique abstracts. 53 articles were included. Adjacent subsites resected, defect size, radiotherapy history, and contraindications to free tissue transfer were identified as key factors influencing decision making and were used to develop the algorithm. Discussion of the reconstructive ladder as it applies to skull base reconstruction and consideration of patient specific factors are reviewed. Patients with a prior history of radiotherapy or with simultaneous resection of multiple anatomic subsites adjacent to the anterior skull base will likely benefit from free tissue transfer.
Reconstruction of anterior skull base defects requires knowledge of the available reconstructive techniques and consideration of defect-specific and patient-specific factors.
前颅底肿瘤开放切除术后产生的缺损难以修复。我们的目标是回顾文献并描述一种循证算法，以指导外科医生修复前颅底缺损。
一名医学信息馆员设计数据库检索策略。两名研究人员独立审查检索出的摘要和全文文章。纳入关于前颅底开放切除术后修复的研究。排除侧颅底和后颅底修复、鼻内镜手术、创伤性和先天性修复的研究。基于该综述，提出了一种修复算法。
检索策略识别出603篇独特的摘要。纳入53篇文章。切除的相邻亚部位、缺损大小、放疗史以及游离组织移植的禁忌证被确定为影响决策的关键因素，并用于制定该算法。回顾了适用于颅底修复的修复阶梯以及对患者特定因素的考虑。有放疗史或同时切除前颅底相邻多个解剖亚部位的患者可能会从游离组织移植中获益。
修复前颅底缺损需要了解可用的修复技术，并考虑缺损特异性和患者特异性因素。
