| ObjectiveThe purpose of this study is to establish a radioanatomical model,carry out the radioanatomical study of HBF,SFF,and transcribiform,transsphenoidal and transclival skull base reconstruction,and evaluate the significance of HBF and SFF for reconstructing transcribiform,transsphenoidal and transclival approaches skull base defect;it also provides preoperative guidance for the approach size selection for transcribiform,transsphenoidal and transclival skull base reconstruction and the preparation of HBF and SFF.Methods1.Specimen Anatomy:7 fresh frozen cadaver head specimens are collected.The distance from the trunk or upper branch of the posterior septal artery to the lower edge of the natural opening of the sphenoid sinus,and the distance from the trunk or lower branch of the posterior septal artery to the upper edge of the choana are measured under endoscopy.The related signs of skull base surgery through the ethmoidal,transsphenoidal and clivus approaches were observed after anatomy.2.Data Measurement:the CT images of 40 Chinese adults were selected to measure the related data of HBF,SFF,and transcribiform,transsphenoidal and transclival skull base reconstruction respectively by means of radioanatomy.3.Results Analysis:the results were analyzed with the method of radioanatomy and SPSS software.4.A comprehensive literature search was conducted using MEDLINE and Pub Med databases,and the retrieval time was from March 2001 to May 2019.The literature was screened and the data extracted by two independent investigators.The Rev Man 5.3 software was used for Meta analysis to calculate the radioanatomic measurements of the mucosal flap required for nasal septum and skull base defects,and to compare the differences between the two.Results1.Among the 14 specimens,the average distance from the trunk or upper branch of the posterior septal artery to the lower edge of the natural opening of the sphenoid sinus was 4.82±2.43mm,and the average distance from the trunk or lower branch of the posterior septal artery to the upper edge of the choana was 8.87±3.09mm.There was no significant difference in t-test of bilateral average value(p=0.231).The anterior ethmoidal artery and the posterior ethmoidal artery were separated before the ophthalmic artery went out of the orbit,and then they passed through the anterior ethmoidal hole and the posterior ethmoidal hole to the superior part of the nasal septum.The average distance between the anterior ethmoidal hole and the anterior wall of the frontal sinus was 13.52±4.34mm,and the average distance between the posterior ethmoidal hole and the sphenoid ethmoidal suture was 5.52±2.17mm.There was no significant difference in t-test of bilateral average value(p=0.309).2.The area of HBF of the 40 cases exceeded the area oft transcribiform approach skull base defec(10.21±1.97cm~2).The width of anterior edge and posterior edge,and the length of superior edge and inferior edge of HBF exceeded the corresponding width and length of transcribiform skull base defect by at least 8.4mm.The total length of HBF including vascular pedicle exceeded the length of transcribiform skull base defect after the reconstruction of anterior sphenoid sinus by at least 17.6mm.The average value of the total length of HBF including vascular pedicle,however,was 7.02±8.71mm less than that of the required length for the transsphenoidal reconstruction of transcribiform skull base defect(which even reached 20.7mm for the least);the area of SFF has far exceeded that of the transcribiform skull base defect(8.93±1.49cm~2);the width of the anterior margin and the posterior margin,and the length of the inferior margin of SFF all exceeded the corresponding width and length of the transcribiform skull base defect,which was in need of reconstruction,by at least 8.4mm,and the length of the superior edge exceeded at least 1.5mm than that of skull base defect to be reconstructed,which was transcribiform approach(9.88±3.83mm);at the same time,we also analyzed the total length data of HBF including vascular pedicle,which was the only one that couldn’t be reconstructed,as well as the scatter diagram,concerning the total length data of transcribiform skull base reconstruction through the sphenoid sinus.3.The areas of HBF in the 40 cases were all larger than that of skull base defect through transsphenoidal approach(10.72±2.04cm~2).The width of the anterior edge and the posterior edge of HBF exceeded that of the middle part and the posterior edge of skull base defect to be reconstructed,which was transsphenoidal approach,by at least 10.7mm.The length of HBF,including the pedicle,exceeded that of HBF required by transsphenoidal approach for reconstruction of planum sphenoidale by7.8mm.The width of the anterior edge of HBF exceeded that of the anterior edge of skull base defect to be reconstructed,which was transsphenoidal approach,by at least5.8mm.The length of HBF,including the pedicle exceeded that of HBF required by transsphenoidal approach for skull base reconstruction by 0.7mm.There was only 1case that the width of the anterior edge of HBF exceeded that of the skull base defect to be reconstructed,which was transsphenoidal approach,by less than 6mm.We analyzed the scatter diagram concerning the total length of HBF,including the pedicle and the length of HBF required for transsphenoidal approach sella turcica reconstruction and only 3 cases did not reach the standard of 3mm.The total length of HBF,including the pedicle,exceeded the length of HBF required for transsphenoidal approach sella turcica reconstruction.4.In 40 cases,the area of HBF exceeded the area of skull base defect through clivus approach(mean 9.01±2.87cm~2).Only in one case,the decrease in value between the anterior width of HBF and middle width of transclival skull base defect didn’t reach 6 mm,and in the rest cases,the differences both in width and length exceeded 6mm;the total length of HBF including vascular pedicle in 40 cases exceeded the total length required for transclival skull base reconstruction by 3mm.5.A total of 4 retrospective analysis results were included.The quality range of NOS score of 146 subjects ranged from 7 to 9.The average length of the septal valve was 73.09±5.17mm,the average width of the level of the anterior ethmoid artery was 43.75±4.13mm,the average width of the junction of the sphaermoid bone was41.93±4.55mm,and the average area of the septal mucosal valve(the reserved10mm olie area)was 26.23±5.17cm2.The average length of the mucosal flap required to cover the defect of the anterior skull base was 49.72±3.68mm,the average horizontal width of the anterior ethmoid artery was 24.65±3.79mm,and the average width of the posterior border of the sphenoid ethmoid bone was 27.06±3.49mm.The difference between the size of the septal flap and the required size of the corresponding skull base defect ranged from-21.03-14.65mm to 17.54-34.28mm.ConclusionHBF and SFF can cover transcribiform,transsphenoidal and transclival skull base defects,and can be used for reconstruction of skull base through three approaches.SFF can cover transcribiform skull base defect and can be used for reconstruction of transcribiforms kull base defect.The method of radioanatomy can be used as a guide for the design of the operation scheme transcribiform,transsphenoidal and transclival approaches before operation. |
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