Calvaruso Federico, Lo Manto Alfredo, Bisi Nicola, Cantaffa Carla, Basso Margherita, Ferrulli Giuseppe, Alicandri-Ciufelli Matteo, Marchioni Daniele
Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy.
Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Verona, Verona, Italy.
Laryngoscope. 2023 Nov;133(11):2942-2947. doi: 10.1002/lary.30921. Epub 2023 Jul 28.
Diffusion of endoscopic techniques for the resection of ethmoid bone malignancies through a transcribriform approach (TA) has raised new challenges regarding reconstruction options to reduce post-operative complications. Although there is consensus on the advantages of vascularized flaps over free grafts for large defects, no standard protocol exists on reconstruction procedures. In addition, although the pedicled nasoseptal flap has been extensively discussed, few studies have been published on extranasal pedicled flaps. The aim of this manuscript is to provide a detailed description of a reconstruction technique for large anterior skull base defects with the pericranial flap as part of a multilayered reconstruction. Moreover, patients treated with this approach were retrospectively assessed for post-operative complications.
A detailed description of the reconstruction procedure as performed in our departments is provided. Pictures depicting the main surgical steps are also included. In addition, preliminary functional results from a retrospective series of patients who underwent a TA and subsequent pericranial flap-based multilayer reconstruction for ethmoid roof malignancies between 2016 and 2022 at two institutional centers are reported.
16 patients were included in the study. Nine patients (56.3%) underwent adjuvant radiotherapy. Two patients had a biochemically-confirmed postoperative CSF leak. Only one of the two patients required surgical revision. During follow-up (mean 13 months), no other early nor delayed complications were observed.
A standardized surgical technique with pericranial flap as part of a multilayered reconstruction for large anterior skull base defects following resection of sinonasal malignancies is proposed, which appears to be a safe choice when endonasal flaps are not available.
Level 4 Laryngoscope, 133:2942-2947, 2023.
经筛板入路（TA）进行筛骨恶性肿瘤切除术的内镜技术的推广，给减少术后并发症的重建选择带来了新的挑战。尽管对于大型缺损采用带血管蒂皮瓣优于游离移植物的优势已达成共识，但在重建程序方面尚无标准方案。此外，尽管带蒂鼻中隔瓣已得到广泛讨论，但关于鼻外带蒂皮瓣的研究报道较少。本手稿的目的是详细描述一种使用颅骨膜瓣进行大型前颅底缺损多层重建的技术。此外，对采用该方法治疗的患者的术后并发症进行了回顾性评估。
提供了我们科室所进行的重建手术的详细描述。还包括描绘主要手术步骤的图片。此外，报告了2016年至2022年期间在两个机构中心接受TA及随后基于颅骨膜瓣的多层重建治疗筛窦顶部恶性肿瘤的一系列患者的初步功能结果。
16例患者纳入研究。9例患者（56.3%）接受了辅助放疗。2例患者术后脑脊液漏经生化证实。2例患者中仅1例需要手术修复。在随访期间（平均13个月），未观察到其他早期或延迟并发症。
提出了一种标准化手术技术，即使用颅骨膜瓣作为鼻窦恶性肿瘤切除术后大型前颅底缺损多层重建的一部分，当鼻内瓣不可用时，这似乎是一种安全的选择。
4级 喉镜，133:2942 - 2947，2023年。
