Modificação na tecnica de reconstrução da base do cranio, em cirurgias do forame jugular e da região petroclival, com retalhos musculares

AUTOR(ES)

Ricardo Ramina

DATA DE PUBLICAÇÃO

2002

RESUMO

The treatment ofskull base pathologies was improved in the Iast 20 years due to the development of new diagnostic methods and surgical techniques. The join efforts of different specialties enlarged the surgical field increasing the potential for postoperative complications. Cerebral spinal fluid fistula is the most :&equentand feared complication of skull base surgery. Usually this complication is related to the surgical procedure. It is more common in anterior and posterior skull base due to their anatomical relation to the paranasal sinuses and mastoid cavity. Aesthetic changes and encephaloceles produced by bone removal or muscular flap rotation are :&equent1yobserved. These problems are in the majority of cases produced by the inadequate reconstruction ofthe skull base defect. The objective of this thesis is to present a new technique of reconstruction of the posterior skull base in surgeries of jugular foramen and petroclival lesions in the prevention of CSF fistulas and encephaloceles with improved aesthetic results. This new reconstruction technique was developed by the author in collaboration with J. Maniglia, M.D. (otorhinolaryngologist), replacing previous surgical procedures used to repair the posterior skull base. To achieve radical tumor removal with control of the important neurovascular structures of this region a wide surgical approach is needed. The resulting large surgical defect associated to removal ofthe infiltrated duramater, with possible communication with the middle ear or mastoid air space, increases the potential for CSF fistula. Adequate reconstruction of the cranial base is of vital importance in these cases. According to a review of the literature the conventional reconstruction techniques with muscular flaps rotation, abdominal fat implants or even myocutaneous grafts with vascular anastomosis may be inadequate concerning prevention of CSF leaks and cosmetic results. We developeda new surgicalstrategy for reconstructionof the posterior skull . base using vascularized flaps of temporal muscle and a flap of the temporalis and cervical fascia with the periosteum of the mastoid region pedicled on the stemocleidomastoid muscle. This technique of reconstruction was used in 66 patients with jugular foramen lesions and in 29 patients with petroclival tumors :&om1987 to 2001

ASSUNTO(S)

cranio - doenças tumores intracranianos base do cranio

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