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Werner MT, Yeoh D, Fastenberg JH, Chaskes MB, Pollack AZ, Boockvar JA, Langer DJ, D’Amico RS, Ellis JA, Miles BA, Tong CCL. Reconstruction of the Anterior Skull Base Using the Nasoseptal Flap: A Review. Cancers (Basel) 2023; 16:169. [PMID: 38201596 PMCID: PMC10778443 DOI: 10.3390/cancers16010169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/17/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
The nasoseptal flap is a workhorse reconstructive option for anterior skull base defects during endonasal surgery. This paper highlights the versatility of the nasoseptal flap. After providing a brief historical perspective, this review will focus on the relevant primary literature published in the last ten years. We will touch upon new applications of the flap, how the flap has been modified to expand its reach and robustness, and some of the current limitations. We will conclude by discussing what the future holds for improving upon the design and use of the nasoseptal flap in anterior skull base reconstruction.
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Affiliation(s)
- Michael T. Werner
- Department of Otolaryngology-Head & Neck Surgery, Northwell Health System, New York, NY 11042, USA; (M.T.W.); (D.Y.); (J.H.F.); (M.B.C.); (A.Z.P.); (B.A.M.)
| | - Desmond Yeoh
- Department of Otolaryngology-Head & Neck Surgery, Northwell Health System, New York, NY 11042, USA; (M.T.W.); (D.Y.); (J.H.F.); (M.B.C.); (A.Z.P.); (B.A.M.)
| | - Judd H. Fastenberg
- Department of Otolaryngology-Head & Neck Surgery, Northwell Health System, New York, NY 11042, USA; (M.T.W.); (D.Y.); (J.H.F.); (M.B.C.); (A.Z.P.); (B.A.M.)
| | - Mark B. Chaskes
- Department of Otolaryngology-Head & Neck Surgery, Northwell Health System, New York, NY 11042, USA; (M.T.W.); (D.Y.); (J.H.F.); (M.B.C.); (A.Z.P.); (B.A.M.)
| | - Aron Z. Pollack
- Department of Otolaryngology-Head & Neck Surgery, Northwell Health System, New York, NY 11042, USA; (M.T.W.); (D.Y.); (J.H.F.); (M.B.C.); (A.Z.P.); (B.A.M.)
| | - John A. Boockvar
- Department of Neurosurgery, Northwell Health System, New York, NY 11042, USA; (J.A.B.); (D.J.L.); (R.S.D.); (J.A.E.)
| | - David J. Langer
- Department of Neurosurgery, Northwell Health System, New York, NY 11042, USA; (J.A.B.); (D.J.L.); (R.S.D.); (J.A.E.)
| | - Randy S. D’Amico
- Department of Neurosurgery, Northwell Health System, New York, NY 11042, USA; (J.A.B.); (D.J.L.); (R.S.D.); (J.A.E.)
| | - Jason A. Ellis
- Department of Neurosurgery, Northwell Health System, New York, NY 11042, USA; (J.A.B.); (D.J.L.); (R.S.D.); (J.A.E.)
| | - Brett A. Miles
- Department of Otolaryngology-Head & Neck Surgery, Northwell Health System, New York, NY 11042, USA; (M.T.W.); (D.Y.); (J.H.F.); (M.B.C.); (A.Z.P.); (B.A.M.)
| | - Charles C. L. Tong
- Department of Otolaryngology-Head & Neck Surgery, Northwell Health System, New York, NY 11042, USA; (M.T.W.); (D.Y.); (J.H.F.); (M.B.C.); (A.Z.P.); (B.A.M.)
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Baussart B, Venier A, Jouinot A, Reuter G, Gaillard S. Closure strategy for endoscopic pituitary surgery: Experience from 3015 patients. Front Oncol 2023; 12:1067312. [PMID: 36686774 PMCID: PMC9846073 DOI: 10.3389/fonc.2022.1067312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/05/2022] [Indexed: 01/05/2023] Open
Abstract
Introduction Effective strategies are required to ensure optimal management of the crucial closure step in endoscopic pituitary surgery. Many surgical techniques have been reported but no significant consensus has been defined. Methods Between January 2006 and March 2022, 3015 adult patients with pituitary adenomas were operated on by a single expert neurosurgical team, using a mononostril endoscopic endonasal approach. Based of preoperative risk factors of and operative findings, a detailed closure strategy was used. Body mass index >40, sellar floor lysis, number of surgeries>2, large skull base destruction, prior radiotherapy were considered as preoperative risk factors for closure failure. All patients treated with an expanded endonasal approach were excluded. Results Patients were mostly women (F/M ratio: 1.4) with a median age of 50 (range: 18 -89). Intraoperative CSF leak requiring specific surgical management was observed in 319/3015 (10.6%) of patients. If intraoperative leak occurred, patients with predictive risk factors were managed using a Foley balloon catheter in case of sellar floor lysis or BMI>40 and a multilayer repair strategy with a vascularized nasoseptal flap in other cases. Postoperative CSF leak occurred in 29/3015 (1%) of patients, while meningitis occurred in 24/3015 (0.8%) of patients. In patients with intraoperative leak, closure management failed in 11/319 (3.4%) of cases. Conclusion Based on our significant 16-year experience, our surgical management is reliable and easy to follow. With a planned and stepwise strategy, the closure step can be optimized and tailored to each patient with a very low failure rate.
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Affiliation(s)
- Bertrand Baussart
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Université Paris Cité, Institut Cochin, CNRS, INSERM, Paris, France,*Correspondence: Bertrand Baussart, ;
| | - Alice Venier
- Department of Neurosurgery, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Anne Jouinot
- Université Paris Cité, Institut Cochin, CNRS, INSERM, Paris, France
| | - Gilles Reuter
- Department of Neurosurgery, Centre Hospitalier Universitaire (CHU) de Liège, Bat B35, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Stephan Gaillard
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Gabriele M, Antonio G, Nicole C, Angelo M, Daniele M. Single Versus Double Hadad-Bassagasteguy Flap in Expanded Endoscopic Skull-Base Surgery. Indian J Otolaryngol Head Neck Surg 2022; 74:394-401. [PMID: 36213480 PMCID: PMC9535070 DOI: 10.1007/s12070-021-02961-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022] Open
Abstract
The reconstruction of dural defects, after endoscopic removal of skull-base lesions, remains challenging when a large defect or a high flow intraoperative cerebrospinal fluid (CSF) leak is observed. The aim of this study is to describe our preliminary experience with a double Hadad-Bassagasteguy (H-B) flap technique for skull-base repair, comparing its efficacy with the use of a single H-B flap in our series. A retrospective chart review was conducted on patients who underwent exclusive endoscopic endonasal skull-base surgery at our Referral Skull Base Center from December 2014 to January 2018. Data on patient demographics, pathology, preoperative and postoperative imaging, intraoperative findings, surgical route, defect size, reconstruction techniques and repair materials, were analyzed. Patients were divided into double and single H-B flap groups. In the single and double H-B groups, the postoperative CSF leak rates were 37.5% (6 of 16 patients) and 4.5% (1 of 22 patients), respectively. The difference between the two groups was statistically significant (p = 0.0470). In patients with defects > 4 cm or high-flow intraoperative CSF leakage related to the opening of the third ventricle, the double H-B flap was successfully placed with no occurrence of postoperative CSF leakage. The double H-B flap significantly reduced the postoperative CSF leakage rate after expanded transnasal skull-base surgery. Particularly in challenging cases, where a large skull-base defect or a high-flow intraoperative CSF leak was observed, this reconstructive method proved to be very effective, with no evidence of postoperative CSF fistulas.
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Affiliation(s)
- Molteni Gabriele
- Otolaryngology Department, Verona University Hospital, Verona, Italy
| | - Gulino Antonio
- Otolaryngology Department, Verona University Hospital, Verona, Italy
| | - Caiazza Nicole
- Otolaryngology Department, Verona University Hospital, Verona, Italy
| | - Musumeci Angelo
- Neurosurgery Department, Verona University Hospital, Verona, Italy
| | - Marchioni Daniele
- Otolaryngology Department, Verona University Hospital, Verona, Italy
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Madapoosi A, Uram Z, Tsiang J, Pecoraro N, Patel C, Germanwala AV. Rathke's cleft cyst marsupialization and repair with a free mucosal graft - Video case report and literature review. Am J Otolaryngol 2022; 43:103519. [PMID: 35690516 DOI: 10.1016/j.amjoto.2022.103519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022]
Abstract
Rathke's cleft cysts (RCCs) are sellar or suprasellar cystic lesions arising from the remnants of the embryological Rathke's pouch. When symptomatic, RCCs are usually treated surgically via marsupialization. Free mucosal graft (FMG) repair has shown promise in decreasing recurrence versus marsupialization alone. The authors present a case report with operative video of a patient with visual and endocrinological symptoms with a RCC treated with FMG following marsupialization. A search of the PubMed database from July 1997 through April 2022 was conducted using the terms 'Rathke's cleft cyst', 'Rathke's cleft cyst management', 'Rathke's cleft cyst repair', 'mucosal graft', 'mucosal coupling', 'transsphenoidal', and 'endoscopic endonasal'. Clinical and pathological aspects of the case presented were compared with information obtained from literature review. A 25-year-old female presented with a six-year history of amenorrhea, one-year history of anemia, headaches, and progressive visual loss. Imaging revealed an RCC. The patient underwent surgical treatment via an endoscopic endonasal approach. Marsupialization was achieved with placement of an FMG to help prevent restenosis. Post-operative examination revealed that the patient's OD vision returned to normal, although her OS vision was only slightly improved. Our review of the English literature resulted in 35 full-length articles that were published between 1997 and 2022. The literature suggests that FMG prevents scar formation by allowing for adequate epithelialization, thus decreasing the recurrence rate and being well tolerated by patients. Our findings support the utility of the FMG as a superior surgical treatment option for RCC management.
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Affiliation(s)
- Adrusht Madapoosi
- Chicago Medical School, Rosalind Franklin University, North Chicago, IL, United States of America
| | - Zachary Uram
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, United States of America
| | - John Tsiang
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, IL, United States of America
| | - Nathan Pecoraro
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, IL, United States of America
| | - Chirag Patel
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, United States of America; Department of Otolaryngology, Head and Neck Surgery, Loyola University Medical Center, Maywood, IL, United States of America
| | - Anand V Germanwala
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, United States of America; Department of Neurological Surgery, Loyola University Medical Center, Maywood, IL, United States of America; Department of Otolaryngology, Head and Neck Surgery, Loyola University Medical Center, Maywood, IL, United States of America.
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Baussart B, Racy E, Gaillard S. Double pedicled nasoseptal flap for skull base repair after endoscopic expanded endonasal approach. Acta Neurochir (Wien) 2022; 164:1111-1114. [PMID: 35094146 DOI: 10.1007/s00701-021-05094-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/16/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Expanded endonasal approach offers a spectacular corridor for skull base tumour resection but requires reliable multilayer reconstruction techniques with a vascularized nasoseptal flap. METHOD On the basis on our substantial experience of 136 patients operated on between January 2008 and January 2020, the double pedicled nasoseptal flap technique was developed for skull base repair. The technique is finely detailed. The nasal floor mucosa was preserved. CSF leakage occurred in 4% of patients. CONCLUSION Double pedicled nasoseptal flap is a reproducible and efficient technique for skull base reconstruction after expanded endonasal approach and is associated with limited rhinological complications.
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di Russo P, Fava A, Giammattei L, Passeri T, Okano A, Abbritti R, Penet N, Bernat AL, Labidi M, Froelich S. The Rostral Mucosa: The Door to Open and Close for Targeted Endoscopic Endonasal Approaches to the Clivus. Oper Neurosurg (Hagerstown) 2021; 21:150-159. [PMID: 34038940 DOI: 10.1093/ons/opab141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Extended endoscopic endonasal approaches (EEAs) have progressively widened the armamentarium of skull base surgeons. In order to reduce approach-related morbidity of EEAs and closure techniques, the development of alternative strategies that minimize the resection of normal tissue and alleviate the use of naso-septal flap (NSF) is needed. We report on a novel targeted approach to the clivus, with incision and closure of the mucosa of the rostrum, as the initial and final step of the approach. OBJECTIVE To present an alternative minimally invasive approach and reconstruction technique for selected clival chordomas. METHODS Three cases of clival chordomas illustrating this technique are provided, together with an operative video. RESULTS The mucosa of the rostrum is incised and elevated from the underlying bone, as first step of surgery. Following tumor resection with angled scope and instruments, the mucosa of the sphenoid sinus (SS) is removed and the tumor cavity and SS are filled with abdominal fat. The mucosal incision of the rostrum is then sutured. A hangman knot is prepared outside the nasal cavity and tightened after the first stitch and a running suture is performed. CONCLUSION We propose, in this preliminary report, a new targeted approach and reconstruction strategy, applying to EEAs the classic concept of skin incision and closure for transcranial approaches. With further development in the instrumentations and visualization tools, this technique may become a valuable minimally invasive endonasal approach for selected lesions.
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Affiliation(s)
- Paolo di Russo
- Department of Neurosurgery, Lariboisiere Hospital, Paris, France
| | - Arianna Fava
- Department of Neurosurgery, Lariboisiere Hospital, Paris, France
| | - Lorenzo Giammattei
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris, Paris, France
| | - Thibault Passeri
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris, Paris, France
| | - Atsushi Okano
- Department of Neurosurgery, Lariboisiere Hospital, Paris, France
| | - Rosaria Abbritti
- Department of Neurosurgery, Lariboisiere Hospital, Paris, France
| | - Nicolas Penet
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris, Paris, France
| | | | - Moujahed Labidi
- Department of Neurosurgery, Lariboisiere Hospital, Paris, France
| | - Sebastien Froelich
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris, Paris, France
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Advances in vascularized flaps for skull base reconstruction. Curr Opin Otolaryngol Head Neck Surg 2021; 29:36-43. [PMID: 33369583 DOI: 10.1097/moo.0000000000000690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Advances in anterior skull base surgery have resulted in the increasing diversification of reconstructive techniques. New vascularized flaps have been suggested in the last years, some quite similar, whereas new uses and applications have been suggested for some vascularized flaps, which have already established their value over the last decades. In this article, we describe the developments in skull base reconstruction with vascularized flaps and analyse the international experience in the use of vascularized flaps published with a focus on the last 18 months. RECENT FINDINGS Over the past 18 months, a number of novel or modified vascularized intranasal flaps have been described, focusing on reconstruction of larger defects, the medial orbital wall, the anterior skull base (septal flip-flap) and dissection of the nasoseptal flap from the SPA foramen. Extranasal vascularized flaps, which have been around for a long time, still have their rightful place in skull base reconstruction and have recently been adjusted for endoscopic use. SUMMARY We present an overview of the latest developments in vascularized flaps (intranasal and extranasal), their new implications, their modifications and complications or predictions of viability.
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Gutierrez WR, Bennion DM, Walsh JE, Owen SR. Vascular pedicled flaps for skull base defect reconstruction. Laryngoscope Investig Otolaryngol 2020; 5:1029-1038. [PMID: 33364390 PMCID: PMC7752068 DOI: 10.1002/lio2.471] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/28/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Techniques for reconstruction of skull base defects have advanced greatly since the introduction of the vascular pedicled nasoseptal flap in 2006. The objective of this review is to assess the current state of the field by examining both intranasal and extranasal techniques of vascular pedicled skull base defect repair, their indications and success rates, and novel techniques that are currently under investigation. METHODS A review of the literature describing the use of vascular pedicled flaps in skull base defect reconstruction was conducted using PubMed and Google Scholar. RESULTS The nasoseptal flap remains the most widely used vascular pedicled flap for endoscopic repair of skull base defects. Its ease of harvest, wide arch of rotation, and high success rates make it a popular choice among surgeons. Several variations including a "rescue" nasopseptal flap have been developed. Other less commonly used pedicled intranasal flaps include the middle turbinate flap and the posterior pedicled inferior turbinate flap. Additionally, several novel vascular pedicled flaps have been developed and tested in small cohorts of patients. Extranasal flaps such as the pericranial flap and the temporoparietal fascia flap are used less frequently than intranasal flaps. However, they remain valuable options for reconstruction in certain situations. CONCLUSION Advancements continue to be made in the field of skull base defect reconstruction using vascular pedicled flaps. Though the nasoseptal flap remains the most widely utilized option, additional intranasal techniques continue to be developed and tested to optimize surgical outcomes and patient care. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Wade R. Gutierrez
- Medical Scientist Training ProgramUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
| | - Douglas M. Bennion
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - Jarrett E. Walsh
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - Scott R. Owen
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
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Sung KS, Lim J, Na M, Lee S, Kim JS, Hong JB, Hong CK, Moon JH. Anterior skull base reconstruction using nasoseptal flap: cadaveric feasibility study and clinical implication [SevEN-001]. J Otolaryngol Head Neck Surg 2020; 49:67. [PMID: 32958073 PMCID: PMC7504836 DOI: 10.1186/s40463-020-00460-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pedicled 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. METHODS In 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. RESULTS Without 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. CONCLUSIONS The 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.
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Affiliation(s)
- Kyoung Su Sung
- Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Jaejoon Lim
- Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, Seongnam, Republic of Korea
| | - Minkyun Na
- Department of Neurosurgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Sanghun Lee
- Department of Neurosurgery, Cheonan Chungmu Hospital, Cheonan, Republic of Korea
| | - Ju-Seong Kim
- Department of Neurosurgery, Ewha Womans Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Je Beom Hong
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chang-Ki Hong
- Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ju Hyung Moon
- Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University College of Medicine
- , 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03772, Republic of Korea.
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Zhong B, Song NY, Deng D, Li LK, Du JT, Liu F, Liu YF, Liu SX. Intraoperative Repair of Cerebrospinal Fluid Rhinorrhea in Skull Base Tumor Resection: A Retrospective Study of Acellular Dermal Matrix Versus Turbinate Flap. World Neurosurg 2019; 133:e275-e280. [PMID: 31518747 DOI: 10.1016/j.wneu.2019.08.245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The acellular dermal matrix (ADM) and turbinate flap (TF) have been widely used in the reconstruction of skull base defects. However, owing to the lack of reported data, the therapeutic effects have been controversial. The purpose of the present study was to compare the effect of the ADM and TF on cerebrospinal fluid (CSF) rhinorrhea after nasal endoscopic resection of a skull base tumor. METHODS The data from 46 patients who had undergone nasal endoscopic resection of a skull base tumor and repair of CSF rhinorrhea were retrospectively analyzed. The patients were divided into ADM and TF groups according to the difference in repair materials used. We compared and analyzed the intraoperative information and postoperative outcomes. RESULTS The operation time, blood loss, defect area, and need for blood transfusion were not significantly different between the ALT and TF groups. The postoperative length of hospital stay (14.33 ± 3.66 vs. 16.76 ± 5.51 days; P = 0.669) and the incidence of complications, including wound infection (1 vs. 0; P = 0.270), intracranial infection (1 vs. 1; P = 0.900), hemorrhage (2 vs. 3; P = 0.788), 15-day CSF leak (1 vs. 2; P = 0.658), and respiratory infection (2 vs. 1; P = 0.450) were comparable between the 2 groups. The 6-month (0 vs. 0; P = 1.000) and 12-month (0 vs. 0; P = 1.000) incidence of recurrence also showed no significant differences. CONCLUSION The use of the ADM for patients with CSF rhinorrhea showed comparable results in terms of postoperative outcomes compared with the use of TF. ADM could serve as a safe and feasible alternative for endoscopic repair of CSF rhinorrhea after nasal endoscopic resection of skull base tumors.
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Affiliation(s)
- Bing Zhong
- Department of Otolaryngology Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ning-Ying Song
- Department of Otolaryngology Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Di Deng
- Department of Otolaryngology Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Lin-Ke Li
- Department of Otolaryngology Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jin-Tao Du
- Department of Otolaryngology Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Feng Liu
- Department of Otolaryngology Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ya-Feng Liu
- Department of Otolaryngology Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| | - Shi-Xi Liu
- Department of Otolaryngology Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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McCormick J, Allen M, Kain JJ, Pena-Garcia JA, Cho DY, Riley KO, Woodworth BA. Lateral nasal wall extension of the nasoseptal flap for skull-base and medial orbital wall defects. Int Forum Allergy Rhinol 2019; 9:1041-1045. [PMID: 31173672 DOI: 10.1002/alr.22364] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/10/2019] [Accepted: 05/16/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sinonasal and skull-base tumors that previously required open resection can often be completely resected via an endonasal approach. The nasoseptal flap (NSF) is the workhorse vascularized tissue flap for the endoscopic reconstruction of large skull-base defects from tumor resections. The objective of the current article is to describe a novel modification of the NSF for simultaneous reconstruction of skull-base and medial orbital wall defects. METHODS An extension of the standard NSF to include mucosa of the lateral nasal wall was developed for closure of simultaneous skull-base and medial orbital wall defects. Outcomes including successful cerebrospinal fluid (CSF) leak closure, orbital edema, and postoperative cosmesis are reported. Eyelid edema was characterized according to the Surgeon Periorbital Rating of Edema and Ecchymosis (SPREE) scale. RESULTS Three patients underwent reconstruction using the modified NSF (average age 75 years). The average defect size of the skull base was 3.6 ± 0.1 cm by 2.3 ± 0.2 cm. The average defect size of the medial orbit was 2.7 ± 0.1 cm by 2.6 ± 0.1 cm. All defects were successfully covered intraoperatively using the lateral nasal wall extension of the NSF. Two patients developed mild eyelid edema, whereas 1 individual had no noticeable swelling (SPREE classification 2, 2, and 1). All patients were successfully sealed at last clinical follow up (average 28 weeks). CONCLUSION The modification of the NSF described here provides excellent coverage for reconstruction of large anterior skull-base defects and simultaneous medial orbital wall defects.
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Affiliation(s)
- Justin McCormick
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Mark Allen
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Joshua J Kain
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Jaime A Pena-Garcia
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Do-Yeon Cho
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Kristen O Riley
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL
| | - Bradford A Woodworth
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
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