cranio-nasal approach repair

Cranio-nasal approach for cerebrospinal fluid rhinorrhea repair is a new surgical method. The main point is to introduce the forehead with vascular pedicle-cap decidua-periosteal flap into the nose, place it on the nose or open sieve. The sphenoid sinus is introduced into the superior wall of the sinus or backwards to repair the leak. Treatment of diseases: pituitary tumors Indication Cerebrospinal fluid leakage in the sieving area and the sella area, large dural holes, and more leakage. For example, after pituitary tumor surgery and trauma, it is difficult to use other methods or free grafts, or it can be repaired by other operations. Preoperative preparation 1. Preoperative systemic examination, including liver and kidney function, cardiopulmonary condition and positive or lateral X-ray of the skull, CT scan of the head, etc., to understand the frontal sinus and skull base; biochemical examination of nasal leakage. 2. Prepare blood. 3. Shave the hair, if you want to take the fascia, you must also prepare the skin in the corresponding area. 4. Preoperative antibiotics, and according to the requirements of general anesthesia to do the necessary preparation and medication, such as preoperative indwelling catheter, atropine sulfate intramuscular injection. 5. Infectious diseases of the nasal cavity and sinuses should be treated and treated with antibiotics. 6. Cut nose hair, shaving and eyebrows. Surgical procedure In two steps: First, the forehead incision is made first, and the vascular pedicle-cap decidual-periosteal flap is removed (the specific method is the same as the pedicled tissue flap through the forehead approach), and then the pedicled tissue flap is selected to enter the nose according to the frontal sinus development. Inside the passage. If the frontal sinus is well developed, the frontal wall of the frontal sinus can be opened with an electric drill or a bone chisel to clear the sinus mucosa and open the frontal sinus floor. If the frontal sinus develops little or does not develop, the frontal bone can be opened in the bone, and the bone window can be opened in the middle or between the midpoint of the eyebrow and the midline, and separated from the epidural, revealing the front of the anterior cranial fossa or The ethmoid horizontal plate is opened with an electric drill or a bone chisel to the front of the skull base, leading to the top of the nasal cavity or the top of the ethmoid sinus, and its size can pass through the pedicle tissue flap. Second, the nasal sinus surgery approach incision, resection of the anterior wall of the ethmoid sinus and the upper air chamber, revealing the frontal sinus floor and the anterior cranial fossa; posterior to the anterior wall of the sphenoid sinus, revealing and expanding the sphenoid sinus opening, open butterfly Anterior sinus wall. At this point, the clear liquid can be seen from the pupil under the microscope. The sinus mucosa was removed. After the operation chamber was rinsed with antibiotic solution, the forehead vascular pedicle flap was delivered into the nose through the frontal sinus or anterior cranial fossa, and the sphenoid sinus was introduced along the nasal tip to repair the leak. Thereafter, the treatment was performed with the cerebrospinal fluid rhinorrhea repair surgery through the forehead approach and the ethmoid sinus approach. In addition to the above four surgical methods, nasal endoscopic cerebrospinal fluid rhinorrhea repair has been used more and more, by finding the nasal leak under nasal endoscopy, clearing the mucosa around the leak, and feeding the repair tissue into the leak. The nasal side was covered with fascia, and the nasal cavity was filled with iodoform gauze, which also achieved good results. The neurosurgeon also used a transsacral pterional approach and a forehead approach to repair the cerebrospinal fluid rhinorrhea in the sellar region. complication 1. Olfactory loss: Transnasal ethmoid sinus surgery approach and forehead approach can damage the olfactory nerve or olfactory structure caused by olfactory loss, and protect the contralateral olfactory nerve and olfactory tissue during surgery. 2. Suppurative meningitis: common in cases where the sinus mucosa is not completely scraped and the graft is filled, the graft infection, liquefaction, necrosis cause intracranial infection, so the sinus cavity must be completely removed when the sinus cavity is filled and repaired. Mucosa. 3. Frontal osteomyelitis: Forehead wound infection or bone window with the same sinus and the sinus mucosa is not completely scraped to cause frontal bone infection, causing osteomyelitis.