BACKGROUND At present,neuroendoscopy technology has made rapid development,and great progress has been made in the operation of lesions in the saddle area of the skull base.However,the complications of cerebrospinal f...BACKGROUND At present,neuroendoscopy technology has made rapid development,and great progress has been made in the operation of lesions in the saddle area of the skull base.However,the complications of cerebrospinal fluid and intracranial infection after the operation are still important and life-threatening complications,which may lead to poor prognosis.AIM To investigate the method of in situ bone flap combined with nasal septum mucosal flap for reconstruction of enlarged skull base defect by endonasal sphenoidal approach and to discuss its application effect.METHODS Clinical data of 24 patients undergoing transnasal sphenoidal endoscopic approach in the Department of Neurosurgery,Affiliated 2 Hospital of Nantong University from January 2019 to December 2022 were retrospectively analyzed.All patients underwent multi-layer reconstruction of skull base using in situ bone flap combined with nasal septum mucosa flap.The incidence of intraoperative and postoperative cerebrospinal fluid leakage and intracranial infection were analyzed,and the application effect and technical key points of in situ bone flap combined with nasal septum mucosa flap for skull base bone reconstruction were analyzed.RESULTS There were 5 cases of high flow cerebrospinal fluid(CSF)leakage and 7 cases of low flow CSF leakage.Postoperative cerebrospinal fluid leakage occurred in 2 patients(8.3%)and intracranial infection in 2 patients(8.3%),which were cured after strict bed rest,continuous drainage of lumbar cistern combined with antibiotic treatment,and no secondary surgical repair was required.The patients were followed up for 8 to 36 months after the operation,and no delayed cerebrospinal fluid leakage or intracranial infection occurred during the follow-up.Computed tomography reconstruction of skull base showed satisfactory reconstruction after surgery.CONCLUSION The use of in situ bone flap combined with vascular pedicled mucous flap to reconstruction of skull base defect after endonasal sphenoidal approach under neuroendoscopy has a lower incidence of cerebrospinal fluid leakage and lower complications,which has certain advantages and is worthy of clinical promotion.展开更多
目的系统评价鼻咽癌患者应用鼻中隔黏膜瓣重建鼻咽部放疗后坏死(PRNN)清创术后鼻咽部缺损的有效性。方法应用计算机检索Pubmed、Cochrane Library、Embase、Web of Science等英文数据库,以及中国知网(CNKI)、万方(WANFANG)、维普(VIP)...目的系统评价鼻咽癌患者应用鼻中隔黏膜瓣重建鼻咽部放疗后坏死(PRNN)清创术后鼻咽部缺损的有效性。方法应用计算机检索Pubmed、Cochrane Library、Embase、Web of Science等英文数据库,以及中国知网(CNKI)、万方(WANFANG)、维普(VIP)等中文数据库,检索时间为自数据库建立至2021年2月1日,检索鼻中隔黏膜瓣修复PRNN术后鼻咽部缺损的临床研究。由两位研究者独立筛选文献、提取资料后,应用RStuido软件进行效应量分析。结局指标为鼻中隔黏膜瓣重建鼻咽部缺损的有效率。此外,搜索并分析仅以鼻咽坏死组织清创治疗PRNN的研究作为参考。结果初次检索获得文献1005篇,根据纳入及排除标准,最终纳入5篇单臂回顾性研究,共145例患者,鼻中隔黏膜瓣重建鼻咽部缺损成功率为84%(95%CI=[0.72,0.96],I 2=74%)。同时,检索到9篇仅以鼻咽坏死组织清创治疗PRNN的研究,其上皮化率为47%(95%CI=[0.31,0.62],I 2=94%)。结论鼻中隔黏膜瓣作为有效的修补材料,可用于PRNN清创手术中鼻咽部缺损的重建,需要更多的前瞻性队列研究或随机对照试验以进一步研究。展开更多
基金Supported by Traditional Chinese medicine science and technology project in Jiangsu province,No.YB2015113the Science and Technology Program of Nantong Health Committee,No.MA2019003,No.MA2021017+5 种基金Thirteenth Five-Year Plan of Nantong Science Education and Health Engineering Medical Key Talent Training Project,No.Key003Fourteenth Five-Year Plan of Nantong Science Education and Health Engineering Medical Key Talent Training ProjectFourth Batch of Municipal Science and Technology Programs in 2015,No.MS12015016Nantong Basic Science and Social Livelihood Science and Technology Program in 2022,No.JCZ2022040Kangda College of Nanjing Medical University 2021 Educational Research Project,No.KD2021JYYJYB025Kangda College of Nanjing Medical University 2022 Educational Research Project,No.KD2022KYJJZD019,No.KD2022KYJJZD022。
文摘BACKGROUND At present,neuroendoscopy technology has made rapid development,and great progress has been made in the operation of lesions in the saddle area of the skull base.However,the complications of cerebrospinal fluid and intracranial infection after the operation are still important and life-threatening complications,which may lead to poor prognosis.AIM To investigate the method of in situ bone flap combined with nasal septum mucosal flap for reconstruction of enlarged skull base defect by endonasal sphenoidal approach and to discuss its application effect.METHODS Clinical data of 24 patients undergoing transnasal sphenoidal endoscopic approach in the Department of Neurosurgery,Affiliated 2 Hospital of Nantong University from January 2019 to December 2022 were retrospectively analyzed.All patients underwent multi-layer reconstruction of skull base using in situ bone flap combined with nasal septum mucosa flap.The incidence of intraoperative and postoperative cerebrospinal fluid leakage and intracranial infection were analyzed,and the application effect and technical key points of in situ bone flap combined with nasal septum mucosa flap for skull base bone reconstruction were analyzed.RESULTS There were 5 cases of high flow cerebrospinal fluid(CSF)leakage and 7 cases of low flow CSF leakage.Postoperative cerebrospinal fluid leakage occurred in 2 patients(8.3%)and intracranial infection in 2 patients(8.3%),which were cured after strict bed rest,continuous drainage of lumbar cistern combined with antibiotic treatment,and no secondary surgical repair was required.The patients were followed up for 8 to 36 months after the operation,and no delayed cerebrospinal fluid leakage or intracranial infection occurred during the follow-up.Computed tomography reconstruction of skull base showed satisfactory reconstruction after surgery.CONCLUSION The use of in situ bone flap combined with vascular pedicled mucous flap to reconstruction of skull base defect after endonasal sphenoidal approach under neuroendoscopy has a lower incidence of cerebrospinal fluid leakage and lower complications,which has certain advantages and is worthy of clinical promotion.
