Qian M, Chen X, Zhang LY, Wang ZF, Zhang Y, Wang XJ. “In situ bone flap” combined with vascular pedicled mucous flap to reconstruction of skull base defect. World J Clin Cases 2023; 11(29): 7053-7060 [PMID: 37946785 DOI: 10.12998/wjcc.v11.i29.7053]
Corresponding Author of This Article
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
Research Domain of This Article
Surgery
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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 byTraditional 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 Processing time: 108 Days and 4.7 Hours
ARTICLE HIGHLIGHTS
Research 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.
Research motivation
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.
Research objectives
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.
Research 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.
Research 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.
Research conclusions
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.
Research perspectives
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.
