鼻中隔黏软骨膜-软骨瓣在颅底缺损修复重建中的应用

目的介绍鼻内镜下纽扣式鼻中隔黏软骨膜一软骨瓣修复颅底硬脑膜缺损的方法，总结其疗效，并探讨其应用适应证。方法回顾性分析应用纽扣式鼻中隔黏软骨膜-软骨瓣鼻内镜下修复颅底肿瘤手术后硬脑膜缺损病例16例，其中嗅神经母细胞瘤5瘤，颅咽管瘤2例，垂体瘤5例，脑膜瘤3例，生殖细胞瘤1例。依据颅底缺损范围的大小，设计鼻中隔取材组织瓣的切取范围，将一侧的部分黏软骨膜及软骨作为整体一并切下，对组织瓣进行修整并环形缝合防黏骨膜撕脱，利用软骨自身的弹性将软骨完全嵌入缺损骨壁的内层，而将黏软骨膜平铺于缺损骨质的外壁，从而形成一种夹层修复。结果所有病例均一次性重建成功，无脑脊液鼻漏和颅内感染发生；5例嗅母细胞瘤和1例生殖细胞瘤患者术后辅助放射治疗，随访6个月以上；其余病例随访6个月至5年，均未发生脑脊液鼻漏及颅内感染。结论鼻内镜下经鼻入路采用纽扣式鼻中隔黏软骨膜-软骨瓣修复颅底肿瘤术后硬脑膜缺损是一种可靠的颅底重建方法。

Application of button typed nasoseptal mucosal cartilage flap to the repair and reconstruction of skull base defect

Objective To introduce the method to repair skull base defect using button-typed nasoseptal mucosal-cartilage flap under endoscope, and to detect the efficacy and indications of this repair method. Methods Clinical data of 16 cases of skull base defect caused by neoplasm resection and repaired with button-typed nasoseptal mucosal-cartilage flap was analyzed retrospectively. The resected neoplasms included olfactory neuroblastoma （5 cases ） , craniopharyngioma （ 2 cases ） , pituitary tumor （ 5 cases ） , meningioma （ 3 cases ） and germ cell tumor （ one case ）. The range of nasoseptal flap was calculated based on that of the defect. An integral flap of mucosa and cartilage on one side of the nasal septum was harvested. The isolated flap was further modified and annularly sutured to prevent avulsion. A dissection reconstruction was performed by inserting the cartilage of the flap into the inner surface of the defect and tiling the mucosa on the outer surface. Results Successful reconstruction was achieved in all cases at once without any postoperative complications such as cerebrospinal fluid rhinorrhea or intracranial infection. Postoperative radiotherapy was applied to 5 olfactory neuroblastoma patients and the germ cell tumor case with follow- up periods of 6 months or more. Other cases without postoperative radiotherapy were followed up for 6 months to 5 years. No cerebrospinal fluid rhinorrhea or intracranial infection occurred during the follow-up period in all cases. Conclusions It is a reliable method to reconstruct the skull base defect with button-typed nasoseptal mucosal- cartilage flap under nasal endoscope.