带蒂鼻中隔黏膜瓣在侵及前颅底鼻腔鼻窦恶性肿瘤切除术颅底重建中的应用

目的　回顾性分析应用带蒂鼻中隔黏膜瓣修复内镜下切除侵及颅底鼻腔鼻窦恶性肿瘤术后颅底缺损的效果。方法　2008年9月～2016年5月内镜下切除侵及颅底鼻腔鼻窦恶性肿瘤31例，应用以鼻后中隔动脉和筛前-筛后动脉为供血的两种类型带蒂鼻中隔黏膜瓣，修复重建前颅底切除后较大颅底缺损。结果　31例患者前颅底重建均一次性修补成功。1例肿瘤复发二次手术患者术后发生脑脊液漏，给予椎管置管引流1周愈合；1例术后10 d撤出鼻腔填塞物后出现脑脊液鼻漏，颅内感染3例，余无颅内出血或血肿等并发症发生。术后随访3～66个月见黏膜瓣愈合良好，无移植瓣膜坏死和脑膜脑膨出发生。结论　血管化带蒂鼻中隔黏膜瓣是内镜颅底外科的一种首选的、可靠的前颅底修补用材料。

Pedicled nasoseptal flap for anterior skull base reconstruction after endoscopic resection of sinonasal malignancies involving the skull base

OBJECTIVE To evaluate the efficacy of the pedicled nasoseptal flap for anterior skull base reconstruction after endoscopic resection of sinonasal malignancies involving the skull base.METHODS From September 2008 to May 2016, 31 patients with sinonasal malignancies involving the skull base were treated via transnasal endoscopic surgery and then two type mucoperiosteal flap of contralateral nasal septum were used to repair the anterior skull base defect according to the actual situation, one is a flap supplied by the posterior nasal septal artery and the other is supplied by the anterior and posterior ethmoidal arteries.RESULTS Successful anterior skull base reconstruction was obtained in all 31 cases. Complications included 3 cases of intracranial infection without hemorrhage or hematoma. In addition, cerebrospinal fluid leakage occurred in one case because of tumor recurrence, and leakage was healed by vertebral draining for one week. Another one had occurred as a result of removing the support form nasal cavity.The follow-up lasted from 3 to 66 months, there were no necrosis of the flap or meningoencephalocele occurred and mucoperiosteal flap healed up well.CONCLUSION The vascularized nasoseptal flap is a reliable and preferred repairing material for anterior skull base reconstruction.