“In situ bone flap” combined with vascular pedicled mucous flap to reconstruction of skull base defect

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.

蝶窦黏液囊肿的临床表现与影像学诊断

蝶窦黏液囊肿少见,仅占鼻窦黏液囊肿的1%。本文总结了自1999年1月～2007年5月本院收治的蝶窦黏液囊肿患者17例,报道如下。1

孤立性蝶窦病变临床分析

孤立性蝶窦病变早期症状无特异性，随着病变的发展，可导致海绵窦综合征和（或）眶尖综合征，从而引起严重并发症，如失明、脑疝等，早期诊断和及时治疗尤为重要。近10年来由于CT、MRI及鼻内镜技术的发展和广泛应用，

蝶窦后鼻孔息肉的临床特点与手术治疗

蝶窦后鼻孔息肉（sphenochoanal polyps）是原发于蝶窦突入鼻腔、鼻咽部的息肉。在临床中较少见,多发于儿童和青少年。随着鼻内镜技术的发展与普及,对该病的诊断与治疗有了更完善的方法。近年来,我科收治4例该病患者，采用鼻内镜下手术治疗，取得了满意的效果，现报道如下。

真菌球型蝶窦炎经鼻内镜手术及疗效分析

真菌球型蝶窦炎早期症状和体征缺乏特异性,常被误诊和漏诊。随着CT及鼻内镜的开展应用,对本病的诊断和治疗有了新的认识。我院自2006年1月～2009年7月对8例真菌球型蝶窦炎患者行鼻内镜微创手术治疗痊愈,现报道如下。

以头痛症状为主要表现的蝶窦良性病变

头痛在临床上非常常见,近年来,由于CT、MRI及鼻内镜技术的广泛应用,明显提高了因蝶窦病变引起头痛的诊断和治疗水平[1]。蝶窦解剖位置深在,毗邻重要的结构,蝶窦病变早期缺乏特异性临床症状和体征,2008年6月～2011年7月我们共收治以头痛为主要临床表现的蝶窦病变22例,病理报告均为良性病变,现将其临床资料报道如下。

蝶筛窦巨大囊肿长期误诊致失明1例

蝶、筛窦巨大囊肿在耳鼻咽喉科并不多见，因长期误诊致失明更少见报道，我科曾收治1例，现报道如下。1临床资料患者，女，42岁，农民，因左眼球突出5年、失明1年，门诊以左鼻肿块收入住院。患者于入院前5年无明显诱因左眼球突出，不伴心悸、多汗、消瘦、食欲亢进，

内镜下经鼻垂体腺瘤术后应用鼻腔清创术的临床效果及对鼻部症状、生活质量的中远期影响

目的探讨内镜下经鼻垂体腺瘤术后应用鼻腔清创术的临床效果及对鼻部症状、生活质量的中远期影响。方法选择2019年4月1日~2021年3月31日宁波市第一医院神经外科收治的94例拟行内镜下经鼻蝶入路垂体腺瘤切除手术患者,随机分为两组,每组各47例。观察组术后4周给予内镜下鼻腔清创术,对照组术后4周未进行鼻腔清创术。分别于术后4周、8周、12周、6个月采用12条鼻部症状评估量表(anterior skull base nasal inventory-12,ASK-12)、鼻阻塞评分(nasal obstruction symptom evaluation,NOSE)、鼻腔鼻窦结局测试(sino-nasal outcome test-20,SNOT-20)评估鼻部症状,中国气味识别测试(Chinese smell identification test,CSIT)评估嗅觉功能,健康调查12条简表(shor tform12-item health survey,SF-12)评估生活质量,并比较两组鼻部并发症发生情况。结果两组术后ASK-12、NOSE、SNOT-20评分逐渐下降(P<0.05),CSIT自评问卷(CSITself)、CSIT嗅觉识别(CSITOI)、SF-12生理(SF-12PCS)、SF-12心理(SF-12MCS)评分逐渐增高(P<0.05)。观察组术后4周、8周、12周、6个月ASK-12、NOSE、SNOT-20评分均低于对照组(P<0.05),CSIT self、CSITOI、SF-12 PCS、SF-12MCS评分高于对照组(P<0.05)。观察组蝶窦炎、萎缩性鼻炎、嗅觉障碍、鼻腔粘连发生率均低于对照组(P<0.05)。结论经鼻蝶窦切除垂体腺瘤术后给予内镜下鼻腔清创术可改善鼻部症状,改善嗅觉功能,提高生活质量,并降低术后鼻部并发症发生率。

Management of Sphenoidal Sinus Lesions by Septal-assisted Approach: Surgical Skills and Advantages

Summary： The aim of this study was to develop a less invasive trans-septal approach for the endo- scopic management of sphenoid sinus lesions. We performed a septal-assisted surgical procedure for endoscopic sphenoidectomy in 38 patients with isolated or combined sphenoidal sinus lesions, including fungal balls, mucoceles, purulent cystic sphenoidal sinusitis, etc. The posterior portion of the nasal sep- turn became flexible after removal of the vomer and the sphenoidal rostrum. The superior portion of the common meatus was expanded to accommodate the endoscope after the septum was repositioned con- tra-laterally. The lesions were individually managed through the enlarged ostiums while damage to the mucosa of the front sphenoidal wall was avoided. All the procedures were completed successfully without intraoperative complications, and the bony ostiums were identified easily and enlarged accu- rately. During the follow-up period of 16 weeks to 2 years, no re-atresia or restenosis was observed. The recurrence rate was 0. No postoperative complications were recorded. All the responses from the pa- tients were satisfactory. It was concluded that endoscopic sphenoidectomy assisted by trans-septal ap- proach is a feasible, safe, effective and minimally invasive approach for selected cases with unilateral or bilateral lesions in the sphenoid sinuses.

以脑脊液鼻漏为表现的蝶窦神经胶质瘤

1临床资料患者,男,66岁,因左侧鼻腔流清水样涕7个月余入院。患者自诉7个月前无明显诱因左侧鼻腔流清水样涕,伴阵发性头痛,头痛呈刺痛,位于双侧颞部,低头时明显;无鼻塞、流脓涕,无鼻腔出血,无视力下降或眼球活动障碍,无恶寒、发热,无头晕等。在当地医院住院后给予抗炎静滴治疗及口服药物治疗,疗效欠佳;转上级医院进一步检查后以脑脊液鼻漏来我院收住院。专科检查：鼻腔黏膜稍充血,鼻中隔向左偏曲,

Study of the relationship between sphenoid sinus volume and protrusions in the sphenoid sinus

The relationship between the volume of sphenoid sinus (SS) and the prevalence of internal carotid artery (ICA) and optic nerve (ON) protrusions in the SS was studied by using high-resolution CT imaging. The ICA and ON protrusions in SS were observed in randomly selected normal head CT scanning images from 350 adult subjects. Ac-cording to the incidence of ICA protrusion, three groups were divided into no ICA protrusion (70.75%), unilateral protrusion (8.68%) and bi-lateral protrusions (20.57%). The ON protrusion accounted for 16% in 350 subjects and accom-panied absolutely with ICA protrusion, but ICA protrusion appeared without accompanying with ON protrusion. The SS volume depended upon the protrusions in it and showed statistical dif-ferences, without ICA protrusion, the smallest size (11.16 ± 1.60) cm3;the unilateral protrusion, medium size (14.20 ± 1.80) cm3 and the bilateral protrusion, the largest size (25.03 ± 2.21) cm3. By observing 3D reconstructed models of ON and SS, we found ON was adjacent to SS (46%) and to posterior ethmoid sinuses (44%). The current study indicates that SS volume is varied with numbers of the protrusions and that ON location varies with the pneumatization of SS. Our results provide an anatomical basis to the surgeries for SS and its surrounding structures.

Sphenoid Sinuses Pneumatization and Association with the Protrusion of Surrounding Neurovascular Structures amongst Beninese

Goal: The aim of this work is to study the relationship between the pneumatization of the adjacent structures of sphenoid sinuses and the protrusion of the neurovascular structures in the sinuses. Methods: A review of 225 CT scans skull was done for subjects aged at least 16 years old from November 1st to December 31st 2017. The pneumatization of adjacent structures of sphenoid sinuses and its relation with the protrusion of neurovascular structures surround the sinuses have been investigated. We used Fischer Exact test for comparison. The p value Results: Statistically significant associations were found between anterior clinoid process bilateral pneumatization and bilateral protrusion of carotid canal (p Conclusion: Compared to the literature, the prevalence of pneumatization of the adjacent structures of sphenoid sinuses was lower on Beninese than Caucasian and Asian. But there were the same correlations with the protrusion of neurovascular structures. In case of endonasal surgery of the sphenoid sinuses, surgeon should be aware of the high possibility the injury of optic nerves and internal carotid artery.

Treatment of Organized Hematoma of the Sphenoid Sinus with Pre-Operative Embolization and Endoscopic Resection

The differential diagnosis for expansile masses of the sphenoid sinuses includes both benign and malignant lesions. We herein present a case of a 79-year-old female who presented with chronic epistaxis and an expansile soft tissue mass centered in the sphenoid sinus with erosion of the skull base. Endoscopic resection of the lesion was performed, with histopathological examination revealing organized hematoma. To our knowl- edge, this is the first reported case of sphenoid sinus organizing hematoma treated with pre-operative embolization followed by endoscopic excision.

Anatomic Variants of Sphenoid Sinuses and Adjacent Structures: A Study of 225 Skull CT Scans at CNHU-HKM in Benin, West Africa

Objective: This study aimed to describe anatomic variants of sphenoidal sinuses and adjacent structures. Methods: A retrospective and descriptive study was carried out at The National and University Teaching Hospital Hubert Koutoukou Maga (CNHU-HKM), of Cotonou in Benin from November 1st to December 31st. A review of CT scans skull was done for the subjects aged at least 16 years old. Anatomic variants of the sphenoid sinuses and adjacent structures have been investigated. Results: 225 CT scans of skull were analyzed. The sellar type was the most common type of pneumatization of sphenoid sinuses (74.7%). Pneumatization of anterior clinoid processes of greater and lesser wings of the sphenoid and of pterygoid processes was observed in 7.1%;4.6%;3.3% and 7.3%;respectively. Protrusion of carotid canals and optic canals, maxillary and vidian nerves were observed in 48.3%;13.1%;18% and 9.5%;respectively. Conclusion: Risky anatomic variants of the sphenoid sinuses and adjacent structures are also described by CT-scan among Beninese. Before any surgery and to avoid bad outcome, a precise approach of these risky anatomic variants must be carried out by using CT-scan.

Incidental Discovery of Sphenoid Sinuses Agenesis: A Report of Two Cases in Benin, West Africa

Sphenoid sinuses are carved into the body of the sphenoid bone. They are probably the most variably pneumatized structures of the skull. They begin their pneumatization at the age of three and finished at adolescence. Several anatomic variants of sphenoid sinuses have been described in the literature. The agenesis of sphenoid sinuses in adults is very rarely found. We report two incidental cases of sphenoid sinuses agenesis discovered on CT scan in Benin, West Africa.

Application and Care of Two Kinds of Sphenoid Sinus Packing Materials after Pituitary Tumor Resection with the Transnasal Endoscopic Approach

Background: Neuroendoscopic transsphenoidal approach for resection of pituitary adenomas has the advantages of less damage, fewer complications, and a faster recovery than the traditional approach and has beening favored by neurosurgeons. However, there has no standard method of selecting suitable packing materials after the operation to relieve pain in patients and achieve the ideal hemostatic effect. We compared the postoperative complications and treatment effects of two different packing materials in patients with pituitary adenomas. Objective: To investigate the advantages and disadvantages of using a catheter balloon and iodoform gauze for hemostasis in patients undergoing pituitary tumor resection by neuroendoscopic transsphenoidal approach. Materials and Methods: We retrospectively analyzed these data of 48 cases treated with pituitary adenoma resection by the single nasal approach from January 2018 to October 2019 in Sun Yat-sen University Cancer Center. According to the type of sphenoid sinus packing material used, these patients were divided into balloon tamponade oppression group (24 cases) and tela iodoformum oppression group (24 cases), respectively. The balloon tamponade oppression group received catheter balloon tamponade oppression hemostasis, and the tela iodoformum oppression group underwent tela iodoformum oppression hemostasis. The outcomes and complications were compared between the two groups in which two kinds of sphenoid sinus packing materials were used for hemostasis after tumor resection by transnasal endoscopic approach. For the catheter balloon compression hemostasis method, on account of the plasticity of the balloon, the volume of water in the balloon can be adjusted according to the size of the patient’s own sphenoid cavity. The amount of bleeding and several complications in terms of discomfort during placement and removal of the packing material, rebleeding after removal of the packing, cerebrospinal fluid rhinorrhea and electrolyte disturbance are compared between the two groups. Results: 48 patients were enrolled. The two groups’ data of patients were similar in age structure, sex ratio, tumor size at baseline and so on. No complications, such as abscess formation, were found in both groups. The success rate in the compression with catheter balloon group was 100% (24 of 24 patients);and in the iodoform gauze group 83.33% (20 of 24 patients). A catheter balloon was more successful in stopping bleeding at early stage than iodoform gauze. There were no statistically significant differences in the hospitalization stay time, operating day to discharge day and tampon indwelling time (P > 0.05). There were also no significant differences in pairwise comparison between the catheter balloon group and iodoform gauze groups in the incidence of cerebrospinal fluid rhinorrhea or electrolyte disturbance between the two groups (P > 0.05). The incidence of headache in the catheter balloon group was statistically significantly lower than that in the iodoform gauze group (P < 0.05). Conclusion: In patients undergoing endoscopic pituitary tumor resection, compression and hemostasis by means of catheterization expansion lead to lower rates of injury and complications and have a good effect, so this method is worthy of being recommended for clinical practice.

Solitary Fungus Ball of the Sphenoid Sinus

A 50-year-old woman with long standing nonspecific disturbing headaches of the mid-face and rear of the head plus retro-orbital pain for about one year duration was proved to suffer from the fungus ball involvement of the left sphenoid sinus after operation. The diagnosis was established by histopathologic examination of the specimen removed at the time of operation.

Use of long implants with distal anchorage in the skull base for treatment of extreme maxillary atrophy: The remote bone anchorage concept

The objectives of this study are to present a new concept of the bone anchorage using long implants in remote bone sites and to discuss four cases treated with this method. Our patients were treated with long implants with a distant anchorage in the skull bone. The planning procedure, the construction of the drill guide, and the surgical protocol are described. In the clinical cases described, all four patients were rehabilitated with the remote bone anchorage concept using long implants anchored in the skull base. Patients were followed for 5-12 years and the implants remained present and stable in these time periods. The skull base implant is a new concept of bone anchorage using long implants. It can be a solution for complicated clinical situations (often failed bone reconstructions and implant placements) or an alternative for bone grafting and maxillary augmentation procedures. There is effective implant retention in the skull base, an anatomical area that is often overlooked for implant placement.

A Rare Case of Nasal Glial Heterotopia Presenting as Sphenochoanal Polyp

Objective: This paper reports a rare case of nasal glial heterotopia presenting as sphenochoanal polyp. So far, literature has revealed only few cases. Case Report: A 55-year-old woman presented with a 2-month history of left sided nasal obstruction. Rigid endoscopy showed greyish left nasal polyp and anterior discharge. Subsequently, CT scan of the sinuses revealed sphenochoanal polyp filling the left nasal cavity, without signs of expansion, or destruction and no obvious connection with intracranial tissue. Mass was removed endoscopically and histology confirmed glial nature of the mass. Conclusion: Any mass arising from sphenoid sinus should be carefully evaluated on CT scan for existence of fibrous stalk, or connection with brain tissue and needs to be considered in the differential diagnosis of the sphenochoanal mass. Complete surgical excision is the treatment of choice, which is curative.

Spheno-Temporal Langerhans Cell Histiocytosis: A Case Report

Langerhans cell histiocytosis (LCH) is a proliferation of Langerhans cells with inflammatory cells, characterized by the activation of histiocytic cells or their proliferation that affects structures of the human body, including the temporal bone which localization is rare in children. The objective of this study is to illustrate the clinical presentation, management and prognosis of this disease, and to compare our case with previously reported series. We report the case of a young 4-year-old patient with a history of otorrhea and recurrent otalgia, with left axillary non-blowing exophthalmia progressive since 5 months associated with indurated left temporal swelling and also an indurated swelling of posterior face of the left shoulder on pathological fracture. A cerebro-orbital MRI performed at home showed an extra-conical process with extension at the temporal fossa. The patient, then, underwent an open-air biopsy of the temporal mass and the pathological analysis returned to favor Langerhans cell histiocytosis. The diagnosis was made by immunohistochemical findings of the S-100 protein and/or the CD1 antigen. The child was treated by chemotherapy with a good outcome. Our results concord with literature. The prognosis is different and better in children with unifocal bone disease than those with a multifocal disease with a survival rate of 65% - 100%.