Introduction

The ability to resect malignancies of the ventral skull base using endoscopic endonasal approaches has created a need for effective endoscopic reconstructive techniques. The purpose of this review is to summarize current techniques for reconstruction of large skull base defects during endoscopic endonasal surgery.

Methods

Recent medical literature was reviewed to identify techniques and best practices for repair of skull base defects during endoscopic endonasal surgery. Preference was given to evidence-based recommendations.

Results

Superior results are observed with multilayer inlay/onlay grafts supplemented with vascularized flaps. The nasoseptal flap is the primary reconstructive flap for most defects; secondary choices include the lateral nasal wall flap and extracranial pericranial flap. Clival defects are particularly challenging and are further augmented with adipose tissue to prevent pontine herniation.

Perioperative management including the use of lumbar cerebrospinal fluid drainage minimizes the risk of a postoperative leak in high-risk patients. Postoperative cerebrospinal fluid leaks are managed similarly to primary leaks and may require use of a secondary vascularized flap. Complications of reconstructive flaps include flap necrosis and cosmetic nasal deformity.

Conclusion

Large defects of the anterior, middle, and posterior cranial fossae can be managed similarly by adhering to basic principles of reconstruction. Future developments will improve stratification of patients into reconstructive groups and allow tailored reconstructive algorithms. New biomaterials may replace autologous tissue and facilitate endoscopic repair. Improved monitoring will allow for assessment of the reconstructive site with early detection and repair of postoperative cerebrospinal fluid leaks.

中文翻译：

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颅底恶性肿瘤内镜手术后的重建

介绍

使用内窥镜鼻内方法切除腹侧颅底恶性肿瘤的能力产生了对有效内窥镜重建技术的需求。本综述的目的是总结目前在内窥镜鼻内手术中重建大颅底缺损的技术。

方法

回顾了最近的医学文献，以确定在内窥镜鼻内手术期间修复颅底缺损的技术和最佳实践。优先考虑基于证据的建议。

结果

使用补充有血管化皮瓣的多层嵌体/高嵌体移植物观察到优异的结果。鼻中隔皮瓣是大多数缺损的主要重建皮瓣；次要选择包括鼻侧壁皮瓣和颅外骨膜瓣。斜坡缺损尤其具有挑战性，并且脂肪组织会进一步增强以防止脑桥疝。

围手术期管理，包括使用腰脑脊液引流术，可最大限度地降低高危患者术后渗漏的风险。术后脑脊液漏的处理与原发漏类似，可能需要使用二级血管化皮瓣。重建皮瓣的并发症包括皮瓣坏死和美容鼻畸形。

结论

前、中、后颅窝的大缺损可以通过坚持重建的基本原则进行类似的处理。未来的发展将改善患者在重建组中的分层，并允许定制的重建算法。新的生物材料可以替代自体组织并促进内窥镜修复。改进的监测将允许评估重建部位，早期发现和修复术后脑脊液渗漏。