Published online Oct 16, 2023. doi: 10.12998/wjcc.v11.i29.7053
Peer-review started: June 27, 2023
First decision: September 4, 2023
Revised: September 10, 2023
Accepted: September 25, 2023
Article in press: September 25, 2023
Published online: October 16, 2023
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.
At present, cerebrospinal fluid leakage is still one of the difficulties after transnasal endoscopic sellar surgery. Our center has also conducted a variety of reconstruction methods for training and clinical use, and this article is a summary of one of them.
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.
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.
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.
In summary, the use of "in situ bone flap" rigid reconstruction technology for the reconstruction of thesellar floor after nasal endoscopic surgery, which is an anatomical reduction repair technology, can not only reduce the incidence of postoperative cerebrospinal fluid leakage, but also has great advantages, worthy of clinical promotion. At present, the number of patients in this group who have been treated with this technique is still small, and the follow-up time is still short.
According to the actual situation of the operation, relevant materials and techniques are adopted according to local conditions, and specific individual treatment plans are formulated for patients, so as to achieve the best surgical treatment effect.