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首页> 外文期刊>The Laryngoscope: A Medical Journal for Clinical and Research Contributions in Otolaryngology, Head and Neck Medicine and Surgery, Facial Plastic and Reconstructive Surgery .. >Minimally invasive endoscopic pericranial flap: a new method for endonasal skull base reconstruction.
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Minimally invasive endoscopic pericranial flap: a new method for endonasal skull base reconstruction.

机译：微创内窥镜颅骨瓣：鼻内颅底重建的新方法。

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OBJECTIVES: One of the major challenges of cranial base surgery is reconstruction of the dural defect. Following a craniofacial resection, the standard reconstructive technique is direct suture repair of the dural defect with a fascial graft and rotation of an anteriorly based pericranial scalp flap to cover the dura. The introduction of endoscopic techniques and an endonasal approach to the ventral skull base has created new challenges for reconstruction. The nasoseptal flap has become the workhorse for vascularized endoscopic skull base reconstruction; however at times, the septal mucosal flap may be unavailable for reconstruction. This can be due to prior surgical resection or involvement of the nasal septum by sinonasal cancer. We have developed a minimally invasive endoscopic pericranial flap for endoscopic skull base reconstruction. The use of a pericranial scalp flap for reconstruction during endonasal skull base surgery using minimally invasive techniques has not been previously reported. METHODS: We performed cadaveric studies to illustrate feasibility of an endoscopic pericranial flap for endonasal skull base reconstruction, then applied this novel technique to an elderly patient after endonasal skull base and dural resection of an esthesioneuroblastoma. RESULTS: The technical report of the minimally invasive pericranial flap is outlined and the advantages and limitations during endonasal skull base reconstruction are discussed. The patient had excellent healing of her skull base and had no evidence of any postoperative cerebrospinal fluid leak. CONCLUSIONS: The minimally invasive endoscopic pericranial flap provides another option for endonasal reconstruction of cranial base defects. There is minimal donor site morbidity, and it provides a large flap that can cover the entire ventral skull base. The issues of intranasal tissue tumor involvement and the need for radiotherapy make the endoscopic pericranial flap an ideal reconstruction for anterior cranial base defects resulting from endonasal sinonasal and skull base cancer resections.
机译：目的：颅底手术的主要挑战之一是硬脑膜缺损的重建。颅面切除术后，标准的重建技术是用筋膜移植物直接缝合硬脑膜缺损，并旋转前基底膜周围头皮瓣覆盖硬脑膜。内窥镜技术的引入和腹侧颅底的鼻内入路为重建带来了新的挑战。鼻中隔皮瓣已成为血管内窥镜颅底重建的主要工具。然而，有时粘膜中隔皮瓣可能无法重建。这可能是由于先前的手术切除或鼻窦癌累及鼻中隔。我们已开发出一种微创内窥镜颅骨瓣，用于内窥镜颅底重建。以前尚未报道过使用微创技术在颅骨颅底外科手术中使用颅骨头皮瓣进行重建。方法：我们进行了尸体研究，以阐明内镜下颅骨皮瓣重建鼻内颅底的可行性，然后将这种新技术应用于老年患者，经鼻颅底和硬膜上皮神经母细胞瘤硬膜切除。结果：概述了微创颅骨瓣的技术报告，并讨论了鼻内颅底重建术的优缺点。该患者的颅底愈合良好，没有任何术后脑脊液漏的证据。结论：微创内镜下颅骨皮瓣为颅底缺损的鼻内重建提供了另一种选择。供体部位的发病率极低，并且提供了一个可以覆盖整个腹侧颅底的大瓣。鼻内组织肿瘤受累的问题以及放疗的需要使内窥镜颅骨瓣成为由鼻内鼻窦和颅底癌切除术导致的前颅底缺损的理想重建。

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