Wingrove Peter M, Arani Keerthi N, Snyderman Carl H, Gardner Paul A, Cabral David T Fernandes, Zenonos Georgios A, Wang Eric W, Chabot Joseph, Fernandez-Miranda Juan C, Chang Yue-Fang, Hughes Marion A
Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States.
Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States.
J Neurol Surg B Skull Base. 2023 Nov 15;85(Suppl 2):e2-e9. doi: 10.1055/s-0043-1776007. eCollection 2024 Oct.
Our objective was to determine if decreased contrast enhancement on postoperative magnetic resonance imaging (MRI) is associated with an increased risk of complication in patients who have undergone nasoseptal flap (NSF) reconstruction. This was a single-institution retrospective study of patients who underwent a first-time endoscopic endonasal approach (EEA) with NSF reconstruction. Patients underwent an EEA to the skull base with NSF reconstruction and received postoperative MRI within 3 weeks of the operation. MR exams were scored on the degree of contrast enhancement at first postoperative MRI. An enhancement score of 4 indicated ≥75% enhancement of the NSF. A score of 3 indicated enhancement ≥50% and <75% enhancement of the NSF. A score of 2 indicated ≥25% and <50% enhancement of the NSF. Complications (e.g., cerebrospinal fluid [CSF] leak, meningitis, empyema, cerebritis, brain abscess, flap necrosis, and flap migration) were retrieved from our institution's skull base database. Logistic regression was used to determine the effect of the MRI enhancement score on the odds of developing a complication. Out of 99 patients in the study, six had complications. Patients who underwent NSF reconstruction of skull base defects were found to have 19 times higher odds of complication ( = 0.007) if they had had an NSF enhancement score of 2 on their postoperative MRI when compared with patients with complete or near complete NSF enhancement (score 4). Quantifying NSF enhancement with an MRI may help surgeons better predict which of their patients are at an increased risk of complication.
我们的目的是确定鼻中隔瓣（NSF）重建术后磁共振成像（MRI）上对比度增强降低是否与并发症风险增加相关。
这是一项单机构回顾性研究，研究对象为首次接受内镜鼻内入路（EEA）并进行NSF重建的患者。
患者接受了经EEA至颅底的NSF重建，并在术后3周内接受了MRI检查。
根据术后首次MRI的对比度增强程度对MR检查进行评分。增强评分为4表示NSF增强≥75%。评分为3表示NSF增强≥50%且<75%。评分为2表示NSF增强≥25%且<50%。并发症（如脑脊液[CSF]漏、脑膜炎、脓胸、脑炎、脑脓肿、瓣坏死和瓣移位）从我们机构的颅底数据库中检索。采用逻辑回归分析来确定MRI增强评分对发生并发症几率的影响。
在该研究的99例患者中，6例出现并发症。与NSF完全或接近完全增强（评分4）的患者相比，接受颅底缺损NSF重建的患者术后MRI的NSF增强评分为2时，发生并发症的几率高19倍（P = 0.007）。
用MRI量化NSF增强可能有助于外科医生更好地预测哪些患者并发症风险增加。
