Crawford Kayva L, Saripella Megana, DeConde Adam S, Beaumont Thomas L
Department of Otolaryngology - Head & Neck Surgery, University of California San Diego, La Jolla, California, United States.
School of Medicine, University of California San Diego, La Jolla, California, United States.
J Neurol Surg Rep. 2023 Aug 11;84(3):e87-e91. doi: 10.1055/s-0043-1772200. eCollection 2023 Jul.
Clival chordoma is a rare, aggressive, notochord-derived tumor primarily managed with surgery via an endoscopic endonasal approach (EEA) and adjuvant proton beam radiotherapy. Reconstruction is commonly performed with a nasoseptal flap (NSF) at the time of initial surgery. While failures of the NSF are rare, they can occur following the initial surgery or in the setting of osteoradionecrosis. Salvage repair typically requires transfer of alternative vascularized tissues outside of the previously radiated field including regional scalp flaps such as pericranial or temporoparietal fascial flaps, or free vascularized tissue transfer. Here we describe the case of a 29-year-old woman with a history of clival chordoma with widespread skull base osteomyelitis secondary to NSF necrosis after proton beam radiotherapy. We describe successful skull base reconstruction with intranasal bilateral inferior turbinate flaps based on the sphenopalatine artery with lateral nasal wall extension, despite prior proton beam therapy and a failed prior vascularized intranasal reconstruction.
斜坡脊索瘤是一种罕见的、侵袭性的、源自脊索的肿瘤，主要通过内镜鼻内入路（EEA）手术及辅助质子束放疗进行治疗。初次手术时通常采用鼻中隔瓣（NSF）进行重建。虽然NSF失败的情况很少见，但可能在初次手术后或发生骨放射性坏死的情况下出现。挽救性修复通常需要在先前放疗区域之外转移替代的带血管组织，包括区域头皮瓣，如颅骨膜瓣或颞顶筋膜瓣，或游离带血管组织转移。在此，我们描述了一名29岁女性的病例，该患者有斜坡脊索瘤病史，在质子束放疗后因NSF坏死继发广泛的颅底骨髓炎。尽管先前接受过质子束治疗且先前的带血管鼻内重建失败，但我们通过基于蝶腭动脉并向鼻侧壁延伸的鼻内双侧下鼻甲瓣成功进行了颅底重建。
