Anterior skull base reconstruction using nasoseptal flap: cadaveric feasibility study and clinical implication [SevEN-001]

Journal of Otolaryngology - Head & Neck Surgery

Chang-Ki Hong¹  Ju Hyung Moon²  Jaejoon Lim³  Sanghun Lee⁴  Kyoung Su Sung⁵  Ju-Seong Kim⁶  Minkyun Na⁷  Je Beom Hong⁸ 

[1] Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea;Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University College of Medicine

[2] , 50-1 Yonsei-ro, Seodaemun-gu, 03772, Seoul, Republic of Korea;Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, Seongnam, Republic of Korea;Department of Neurosurgery, Cheonan Chungmu Hospital, Cheonan, Republic of Korea;Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea;Department of Neurosurgery, Ewha Womans Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea;Department of Neurosurgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea;Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea;

关键词: Anterior skull base;    Nasoseptal flap;    Sphenoidotomy;    Skull base reconstruction;   

DOI  :  10.1186/s40463-020-00460-3

来源: Springer

【 摘 要 】

BackgroundPedicled nasoseptal flap (PNSF) has significantly improved the surgical outcomes of endoscopic endonasal approach (EEAs) by reducing cerebrospinal fluid (CSF) leakage. The purpose of this study is to assess the feasibility of using a PNSF for anterior skull base (ASB) reconstruction and to describe a method to compensate for a short flap based on our results.MethodsIn this cadaveric study, ASB dissection without sphenoidotomy was performed using 10 formalin-fixed and 5 fresh adult cadaver specimens, and the sufficiency of the PNSF to cover the ASB was assessed. After the sphenoidotomy, the length by which the PNSF fell short in providing coverage at the posterior wall of the frontal sinus (CPFS), and the extent of the anterior coverage from the limbus (CL) of the sphenoid bone was measured.ResultsWithout sphenoidotomy, the mean length of the remaining PNSF after the coverage of the posterior wall of the frontal sinus was 0.67 cm. After sphenoidotomy, the PNSF fell short by a mean length of 2.10 cm, in providing CPFS. The CL was 1.86 cm. Based on these findings, defects resulting from an endoscopic resection of ASB tumors were reconstructed using PNSF without total sphenoidotomy in 3 patients. There were no postoperative CSF leaks or complications.ConclusionsThe use of PNSF for ASB reconstruction may be insufficient to cover the entire ASB defect after removal of large lesions which need total sphenoidotomy. When possible, by leaving some portion of the anterior sphenoid wall for supporting the PNSF, successful ASB reconstruction could be achieved in endoscopic resection of ASB tumors. Additional methods might be needed in some cases of large ASB lesions wherein the anterior sphenoid wall should be removed totally and the ASB defect is too large.

【 授权许可】

CC BY