带蒂鼻中隔瓣在经鼻内镜颅底重建中作用的影像解剖学研究

Radioanatomic study on the role of Hadad-Bassagasteguy flap in skull base reconstruction in endoscopic endonasal approach

目的通过对中国成人颅底CT前颅底缺损及重建、蝶骨平台区及包括蝶骨平台、蝶鞍区在内的中颅底缺损及重建、斜坡区缺损及重建的相关数据进行测量,并结合Hadad-Bassagasteguy 瓣(Hadad-Bassagasteguy flap,HBF)的放射解剖学数据的测量,综合评价HBF在颅底重建中的应用价值。方法选择42例中国成人CT影像资料进行前颅底缺损及重建、中颅底缺损及重建、斜坡区缺损及重建数据的测量以及HBF的放射解剖学数据测量,使用SPSS 26.0软件对结果进行分析比较。结果 42例中国成人CT颅底相关数据及HBF测量结果为:HBF前缘宽度(37.49±2.86)mm,超过两侧筛前动脉之间宽度[(30.87±8.61)mm] 6 mm以上,后缘宽度(42.61±3.95)mm,超过两侧蝶筛缝之间宽度[(26.79±2.79)mm] 6 mm以上,包括血管蒂在内HBF的总长度(79.68±4.96)mm,超过前颅底重建长度[(54.06±8.67)mm] 6 mm以上,而不含血管蒂的HBF长度(46.27±3.14)mm,超过前颅底缺损长度[(30.87±8.61)mm] 6 mm以上。HBF后缘宽度超过两侧视柱之间宽度[(30.87±8.61)mm] 6 mm以上,包括血管蒂在内HBF总长度分别超过蝶骨平台、蝶骨平台重建长度[(73.61±8.28)mm] 、蝶鞍区重建长度[(64.44±10.25)mm] 6 mm以上,而不含血管蒂的HBF长度分别也超过了蝶骨平台缺损长度[(15.50±3.38)mm]、蝶骨平台蝶鞍区缺损长度[(27.88±3.74)mm] 6 mm以上。HBF前缘宽度、后缘宽度均超过两侧颈内动脉斜坡旁段与岩骨段连接处之间宽度[(21.68±2.30)mm] 6 mm以上,包括血管蒂在内HBF总长度超过斜坡重建长度[(67.09±5.44)mm] 6 mm以上,而不含血管蒂的HBF长度也超过了斜坡缺损长度[(37.19±3.80)mm] 6 mm以上。结论 HBF可以为前颅底、蝶骨平台区及蝶骨平台和蝶鞍区、斜坡区重建提供足量的组织瓣。术前可以应用放射解剖测量方法预测颅底重建所需HBF的大小,为术中提前获取并保护好HBF提供重要参考。

Objective To evaluate the value of Hadad-Bassagasteguy flap(HBF)in endoscopic endonasal approaches(EEA)skull base reconstruction by radioanatomic measurements on CT of the skull base of Chinese adults.The following data in terms of anterior skull base defect and reconstruction,sphenoid platform area and middle skull base defect and reconstruction including sphenoid platform and sella area,clivus area defect and reconstruction,and HBF were collected and assessed.Methods CT image data of 42 Chinese adults were selected to obtain radioanatomic measurement data related to HBF,anterior skull base defect and reconstruction,middle skull base defect and reconstruction,and defect and reconstruction of clivus area.SPSS 26.0 software was used to analyze the data.Results The radioanatomic measurement data about HBF and skull base of 42 Chinese adults were obtained.The width of the leading edge of HBF[(37.49±2.86)mm]was 6 mm more than the anterior skull base width at the level of the anterior ethmoidal artery[(30.87±8.61)mm],and the width of the trailing edge of HBF[(42.61±3.95)mm]was also 6 mm more than the anterior skull base width at the level of the sphenoethmoidal junction[(26.79±2.79)mm].The total length of HBF including the pedicle[(79.68±4.96)mm]was 6 mm more than the length of the anterior skull base reconstruction[(54.06±8.67)mm],and the length of HBF without pedicle[(46.27±3.14)]mm was 6 mm more than the length of anterior skull base defect[(30.87±8.61)mm].The trailing edge width was 6 mm more than the planum sphenoidal width at the level of the optic strut[(30.87±8.61)mm].The total length of HBF including the pedicle was 6 mm more than the length of the planum sphenoidal,and the sella reconstruction[(64.44±10.25)mm],also was 6 mm more than the length of the planum sphenoidal reconstruction[(73.61±8.28)mm].The length of HBF without pedicle was 6 mm more than the length of the planum sphenoidal,and the sella defect[(27.88±3.74)mm],also was 6 mm more than the length of the planum sphenoidal defect[(15.50±3.38)mm].The width of the leading edge of HBF and the width of the trailing edge were both 6 mm more than the width of clivus reconstruction at the level of the foramen lacerum[(21.68±2.30)mm].The total length of HBF including pedicles was 6 mm more than the clivus reconstruction length[(67.09±5.44)mm],while the length of HBF without pedicles was also 6 mm more than the clivus defect length[(37.19±3.80)mm].Conclusions In this study,the radiosanatomic measurements ensured that HBF could provide sufficient tissue flap for the reconstruction of the anterior skull base and sphenoid plateau and extend the reconstruction area to sella and clivus.Preoperative radiosanatomic measurement can be used to predict the size of HBF required for skull base reconstruction,which provides important guidance for flap harvest.