Sinonasal radioanatomy applied in the reconstruction of the cranial base in endoscopic endonasal epproaches
Keywords:
skull base, anatomy, neuroendoscopy, cerebrospinal fluid leak, surgical flapsAbstract
Introduction: Endoscopic Endonasal Approaches revolutionized skull base neurosurgery. One of the biggest challenges is the efficient reconstruction of the skull base and the vascularized nasoseptal flap is a fundamental element to achieve it, knowing its dimensions and its preoperative extension capacity is essential in the reconstruction of the cranial base.
Objective: To describe the radioanatomical characteristics of the patients and to estimate a safety index of the vascularized nasoseptal flap for skull base repair.
Method: It was carried out a descriptive study in 50 patients from the Hermanos Ameijeiras Hospital operated on for various skull base tumors using ESA, in which they were assessed sinonasal radioanatomical variables: estimated length and width of the nasoseptal flap, necessary length and width of the osteotomy and it was obtained a safety index from it.
Results: A safety index greater than 1 of the length of the nasoseptal flap was evident in 94% of the cases, however, the safety index greater than 1 of the width of the flap varied from 44% to 96% depending on whether the standard flap was used or the expanded one respectively. All cases with safety indexes less than 1 corresponded to giant meningiomas of the olfactory groove. We can conclude that the personalized use of the standard or expanded nasoseptal flap according to the sinonasal radioanatomical variables guarantees a successful repair in most cases; however, in giant meningiomas of the olfactory groove the use of the pericranial flap should be considered.
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