早期使用颞肌筋膜瓣修复创伤性损伤并预防脑脊液漏：病例说明
Upfront use of temporal myofascial flap for repair of traumatic injury and prevention of CSF leaks: illustrative cases.
作者信息
Rao Aliana N, Ricci Samuel L, Pathak Sami, Hannah Theodore, Ziechmann Robert, Villanueva Philip
机构信息
Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.
Department of Neurosurgery, Temple University Hospital, Philadelphia, Pennsylvania.
出版信息
J Neurosurg Case Lessons. 2025 Sep 1;10(9). doi: 10.3171/CASE25412.
BACKGROUND
Traumatic brain injury involving destruction of the mastoid bone leading to a large defect in the middle fossa floor or posterior fossa dura can necessitate delayed or multistep repairs or reconstruction of the middle fossa floor because of a CSF leak and rhinorrhea. Delayed repair may be associated with CNS infection. Reconstruction using a temporalis myofascial flap has been described in delayed reconstruction cases with CSF leak. The authors report a novel concept of upfront repair.
OBSERVATIONS
Two patients with gunshot wound injuries involving the mastoid and middle fossa floor or posterior fossa dura underwent decompression and simultaneous early reconstruction with a temporalis myofascial flap sutured to the middle fossa dura. Both patients avoided prolonged CSF leak and had no complications from this approach.
LESSONS
Upfront repair of traumatic defects of the middle fossa floor or posterior fossa dura involving the mastoid air cells may avoid a prolonged CSF leak and its complications. https://thejns.org/doi/10.3171/CASE25412.
背景
创伤性脑损伤若累及乳突骨破坏，导致中颅窝底或后颅窝硬脑膜出现大的缺损，由于脑脊液漏和鼻漏，可能需要延迟或多步骤修复或重建中颅窝底。延迟修复可能与中枢神经系统感染有关。在脑脊液漏的延迟重建病例中，已描述了使用颞肌筋膜瓣进行重建。作者报告了一种早期修复的新概念。
观察结果
两名因枪伤累及乳突和中颅窝底或后颅窝硬脑膜的患者接受了减压，并同时用缝合至中颅窝硬脑膜的颞肌筋膜瓣进行早期重建。两名患者均避免了长时间的脑脊液漏，且该方法无并发症。
经验教训
涉及乳突气房的中颅窝底或后颅窝硬脑膜创伤性缺损的早期修复可避免长时间的脑脊液漏及其并发症。https://thejns.org/doi/10.3171/CASE25412 。
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