비중격 피판과 대퇴근막을 이용한 의인성 두개저 결손의 내시경적 재건
Endoscopic Repair With Contralateral Septal Flap and Fascia Lata for Iatrogenic Skull Base Defect
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초록
Iatrogenic skull base injury may occur during sinus surgery, and endoscopic repair is consid-ered the gold standard for treatment. We report a 65-year-old male who experienced an iatro-genic ethmoid roof defect caused by endoscopic sinus surgery, eventually leading to four re-operations of endoscopic repairs. Autologous fascia lata and contralateral nasoseptal flap weremainly utilized for this revision case. Following 29 days of hospitalization, which includedabsolute bed rest with lumbar drainage for 22 days, there was a gradual improvement in thecerebrospinal fluid (CSF) profile and mental status. Additionally, the patient underwent ven-triculoperitoneal shunt placement to address non-obstructive hydrocephalus resulting frommeningitis, ultimately allowing him to return to his normal daily life. Critical factors in man-aging large skull base defects with high-flow CSF leakage include multi-layer reconstructionwith fascia lata and a pedicled nasoseptal flap, sufficient control of intracranial pressure withCSF drainage and positioning, and infection control through appropriate antibiotics.
Abstract
Iatrogenic skull base injury may occur during sinus surgery, and endoscopic repair is consid-ered the gold standard for treatment. We report a 65-year-old male who experienced an iatro-genic ethmoid roof defect caused by endoscopic sinus surgery, eventually leading to four re-operations of endoscopic repairs. Autologous fascia lata and contralateral nasoseptal flap weremainly utilized for this revision case. Following 29 days of hospitalization, which includedabsolute bed rest with lumbar drainage for 22 days, there was a gradual improvement in thecerebrospinal fluid (CSF) profile and mental status. Additionally, the patient underwent ven-triculoperitoneal shunt placement to address non-obstructive hydrocephalus resulting frommeningitis, ultimately allowing him to return to his normal daily life. Critical factors in man-aging large skull base defects with high-flow CSF leakage include multi-layer reconstructionwith fascia lata and a pedicled nasoseptal flap, sufficient control of intracranial pressure withCSF drainage and positioning, and infection control through appropriate antibiotics.
참고문헌 (9)
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