Ferlendis Luca, Bossi Bianca, Tabano Antonio, Bifone Lidia, Arosio Alberto Daniele, Espinoza Apolo Paula Nathalie, Pozzi Fabio, Coden Elisa, Bignami Maurizio, Castelnuovo Paolo, Locatelli Davide
Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Luigi Borri, 57, 21100 Varese, Italy.
Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Luigi Borri, 57, 21100 Varese, Italy.
J Clin Med. 2024 Nov 28;13(23):7229. doi: 10.3390/jcm13237229.
: To evaluate the outcomes of anterior skull base (ASB) reconstruction using single versus double vascularized flap techniques following multiportal cranio-endoscopic approaches (CEA), based on a 12-year experience. : A retrospective analysis was conducted on 46 patients who underwent ASB reconstruction after a CEA at our department between 2010 and 2022. Patients were divided into two groups: Group 1 received a pericranial flap (PF) reinforced with a fascia graft, while Group 2 underwent multiple flap reconstruction with PF, fascia graft, and nasoseptal flap (NSF). The primary outcome measured was the incidence of cerebrospinal fluid (CSF) leakage and the impact of adjuvant radiotherapy (RT) on reconstruction. : Group 1 (86.9%) demonstrated no significant postoperative CSF leaks, showing that the PF, combined with multilayer techniques (including underlay sealing matrix and overlay fascia graft), effectively repaired ASB defects. Group 2 (13.1%), employing both PF and NSF, showed similar outcomes, with the dual flap approach particularly beneficial in cases of post-traumatic fistulas or when the nasal septum was spared by disease. No significant differences were observed in complications or flap necrosis, even in patients receiving adjuvant RT. : The PF is a reliable and versatile option for ASB reconstruction, often sufficient as a single-flap technique. The addition of an NSF can be beneficial in specific cases, particularly in post-traumatic conditions or tumors with unilateral endonasal invasion. However, PF alone, when combined with a multilayer approach, minimizes the risk of CSF leakage and long-term flap necrosis, underscoring the importance of tailored surgical strategies for optimal outcomes.
基于12年的经验，评估在多通道颅内镜手术（CEA）后使用单血管化皮瓣技术与双血管化皮瓣技术进行前颅底（ASB）重建的效果。：对2010年至2022年期间在我科接受CEA后进行ASB重建的46例患者进行回顾性分析。患者分为两组：第1组接受用筋膜移植加强的颅骨膜瓣（PF），而第2组采用PF、筋膜移植和鼻中隔瓣（NSF）进行多瓣重建。测量的主要结果是脑脊液（CSF）漏的发生率以及辅助放疗（RT）对重建的影响。：第1组（86.9%）术后未出现明显的CSF漏，表明PF联合多层技术（包括衬里密封基质和覆盖筋膜移植）可有效修复ASB缺损。第2组（13.1%）采用PF和NSF，显示出相似的结果，双瓣方法在创伤后瘘管病例或鼻中隔未受疾病影响的情况下特别有益。即使在接受辅助RT的患者中，并发症或皮瓣坏死方面也未观察到显著差异。：PF是ASB重建的一种可靠且通用的选择，通常作为单瓣技术就足够了。在特定情况下，添加NSF可能有益，特别是在创伤后情况或单侧鼻内侵犯的肿瘤中。然而，单独的PF与多层方法相结合时，可将CSF漏和长期皮瓣坏死的风险降至最低，强调了制定个性化手术策略以实现最佳结果的重要性。
