Huang Yu-Wen, Wang Wei-Hsin, Lan Ming-Ying
Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Eur Arch Otorhinolaryngol. 2025 Apr;282(4):1921-1927. doi: 10.1007/s00405-025-09213-2. Epub 2025 Jan 25.
The escalating number of endoscopic skull base procedures necessitates exploring additional materials to reduce postoperative cerebrospinal fluid (CSF) leaks in revision or staged surgeries. This study evaluates the effectiveness of reused nasoseptal flaps (NSFs) in such clinical scenarios.
A retrospective review was conducted on patients who previously underwent surgery involving NSFs and later had revision or secondary skull base surgeries via endoscopic endonasal approaches (EEAs) at a tertiary medical center. Patients were divided into two groups: one with reused NSFs and the other without. Demographics, intraoperative CSF leaks, reconstruction materials, postoperative morbidity, and time to complete mucoepithelialization of the defect were analyzed.
The study included 20 patients with prior NSF usage who underwent secondary EEAs. Thirteen cases utilized reused NSFs alone or with inlay fat or fascia lata, while the remaining seven employed other materials. Pathology type disparity was significant (p = 0.031). Reused NSF demonstrated a 100% success rate in reducing CSF leaks. The average time for mucoepithelization was 61 days (SD = 34 days).
Reusing NSF in revision or staged surgeries is a reliable technique for skull base repair, potentially reducing nasal morbidity and obviating the need for harvesting other vascular flaps.
内镜颅底手术数量不断增加，这就需要探索更多材料以减少翻修手术或分期手术中的术后脑脊液（CSF）漏。本研究评估了在这种临床情况下重复使用鼻中隔瓣（NSF）的有效性。
对一家三级医疗中心此前接受过涉及NSF手术且后来通过鼻内镜鼻内入路（EEA）进行翻修或二次颅底手术的患者进行回顾性研究。患者分为两组：一组使用重复使用的NSF，另一组未使用。分析了人口统计学数据、术中脑脊液漏、重建材料、术后发病率以及缺损黏膜上皮化完成时间。
该研究纳入了20例曾使用过NSF并接受二次EEA的患者。13例单独使用重复使用的NSF或联合使用嵌体脂肪或阔筋膜，其余7例使用其他材料。病理类型差异具有统计学意义（p = 0.031）。重复使用的NSF在减少脑脊液漏方面成功率达100%。黏膜上皮化的平均时间为61天（标准差 = 34天）。
在翻修手术或分期手术中重复使用NSF是颅底修复的可靠技术，可能会降低鼻腔发病率并避免采集其他血管化皮瓣的需要。
