Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2023; 11(29): 7053-7060
Published online Oct 16, 2023. doi: 10.12998/wjcc.v11.i29.7053
“In situ bone flap” combined with vascular pedicled mucous flap to reconstruction of skull base defect
Ming Qian, Xi Chen, Long-Yao Zhang, Zhi-Feng Wang, Yi Zhang, Xue-Jian Wang
Ming Qian, Long-Yao Zhang, Zhi-Feng Wang, Yi Zhang, Xue-Jian Wang, Department of Neurosurgery, Affiliated Hospital 2 of Nantong University, Nantong 226000, Jiangsu Province, China
Xi Chen, Department of Nursing, Affiliated Hospital 2 of Nantong University, Nantong 226001, Jiangsu Province, China
Xue-Jian Wang, Department of Neurosurgery, Nantong Clinical Medical College, Kangda College, Nanjing Medical University, Nantong 226000, Jiangsu Province, China
Author contributions: Wang XJ and Qian M treated this patient; Zhang Y and Wang ZF collected the data; Chen X and Zhang LY analyzed the data; Wang XJ wrote the manuscript; Chen X revised and checked this article; All authors contributed to the article and approved the submitted version.
Supported by Traditional Chinese medicine science and technology project in Jiangsu province, No. YB2015113; the Science and Technology Program of Nantong Health Committee, No. MA2019003, No. MA2021017; Thirteenth Five-Year Plan of Nantong Science Education and Health Engineering Medical Key Talent Training Project, No. Key003; Fourteenth Five-Year Plan of Nantong Science Education and Health Engineering Medical Key Talent Training Project; Fourth Batch of Municipal Science and Technology Programs in 2015, No. MS12015016; Nantong Basic Science and Social Livelihood Science and Technology Program in 2022, No. JCZ2022040; Kangda College of Nanjing Medical University 2021 Educational Research Project, No. KD2021JYYJYB025; Kangda College of Nanjing Medical University 2022 Educational Research Project, No. KD2022KYJJZD019, No. KD2022KYJJZD022.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Affiliated 2 Hospital of Nantong University. Informed consent has been obtained and this investigation has been conducted according to the principles expressed in the Declaration of Helsinki. And the authors have obtained written informed consent of all the patients or legal guardian.
Conflict-of-interest statement: All authors has nothing to disclose.
Data sharing statement: The data related to the article can be obtained from the corresponding author via email: 6841441@163.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xue-Jian Wang, MD, PhD, Professor, Surgeon, Department of Neurosurgery, Affiliated Hospital 2 of Nantong University, No. 666 Shengli Road, Chongchuan District, Nantong 226000, Jiangsu Province, China. 6841441@163.com
Received: June 27, 2023
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
Abstract
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.

Keywords: In situ bone flap, Nasal septum mucosa flap, Multilayer reconstruction, Skull base reconstruction, Neuroendoscopy, Endonasal sphenoidal approach

Core Tip: 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.