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Abstract：
OBJECTIVE: The current approach for the diagnosis and repair of spontaneous and traumatic anterior skull-base defects is oulined, highlighting the controversies that exist in the field and describing the strategies required to access different segments of the anterior cranial fossa.
METHODS: We reviewed the literature concerning endoscopic management of anterior skull-base defects. These publications have been combined with our own experience repairing cerebrospinal fluid (CSF) leaks and encephaloceles that developed spontaneously, traumatically, or intentionally as a result of endoscopic skull-base surgery.
RESULTS: We present a systematic methodology for the repair of these defects. We have divided our surgical approach into four separate corridors. These are the transnasal, transsphenoidal, transethmoidal, and transmaxillary corridors. Dissection strategies vary for each corridor, but with a combination of approaches, all areas of the anterior skull base can be accessed. Skull-base defects are successfully repaired with a multilayered closure that often involves use of a vascularized pedicled mucosal flap. Adoption of this technique has decreased our rate of postoperative CSF leak from 5.9%-3.1%.
CONCLUSIONS: Endoscopic endonasal repair of CSF leaks and encephaloceles has evolved significantly during the past decade. The versatility of different endoscopic approaches through the four endonasal corridors allows for the endoscopic repair of almost all skull-base defects. The use of vascularized pedicled mucosal flaps has evolved to cover these defects as part of multilayered closure strategies.
METHODS: We reviewed the literature concerning endoscopic management of anterior skull-base defects. These publications have been combined with our own experience repairing cerebrospinal fluid (CSF) leaks and encephaloceles that developed spontaneously, traumatically, or intentionally as a result of endoscopic skull-base surgery.
RESULTS: We present a systematic methodology for the repair of these defects. We have divided our surgical approach into four separate corridors. These are the transnasal, transsphenoidal, transethmoidal, and transmaxillary corridors. Dissection strategies vary for each corridor, but with a combination of approaches, all areas of the anterior skull base can be accessed. Skull-base defects are successfully repaired with a multilayered closure that often involves use of a vascularized pedicled mucosal flap. Adoption of this technique has decreased our rate of postoperative CSF leak from 5.9%-3.1%.
CONCLUSIONS: Endoscopic endonasal repair of CSF leaks and encephaloceles has evolved significantly during the past decade. The versatility of different endoscopic approaches through the four endonasal corridors allows for the endoscopic repair of almost all skull-base defects. The use of vascularized pedicled mucosal flaps has evolved to cover these defects as part of multilayered closure strategies.
摘要：
目的：目前用于诊断和修复自发性和创伤性前颅底缺损的方法是，强调了该领域存在的争议，并描述了进入前颅窝不同节段所需的策略。
方法：我们回顾了有关前颅底缺损的内镜治疗的文献。这些出版物与我们自己的经验相结合，修复自发发展的脑脊液（CSF）泄漏和脑囊肿，创伤,或故意作为内窥镜颅底手术的结果。
结果：我们提出了修复这些缺陷的系统方法。我们将手术方法分为四个独立的走廊。这些是经鼻的，经蝶窦,跨动脉，和上颌走廊。每个走廊的解剖策略各不相同，但是结合各种方法，可以进入前颅底的所有区域。颅底缺损可以通过多层闭合成功修复，多层闭合通常涉及使用血管化的带蒂粘膜瓣。采用该技术已将我们的术后CSF泄漏率从5.9％降低到3.1％。
结论：在过去的十年中，内窥镜鼻内修复脑脊液漏和脑囊肿有了显著的发展。通过四个鼻内通道的不同内窥镜方法的多功能性允许内窥镜修复几乎所有颅底缺损。作为多层闭合策略的一部分，血管化带蒂粘膜瓣的使用已经发展成为覆盖这些缺陷的一部分。
方法：我们回顾了有关前颅底缺损的内镜治疗的文献。这些出版物与我们自己的经验相结合，修复自发发展的脑脊液（CSF）泄漏和脑囊肿，创伤,或故意作为内窥镜颅底手术的结果。
结果：我们提出了修复这些缺陷的系统方法。我们将手术方法分为四个独立的走廊。这些是经鼻的，经蝶窦,跨动脉，和上颌走廊。每个走廊的解剖策略各不相同，但是结合各种方法，可以进入前颅底的所有区域。颅底缺损可以通过多层闭合成功修复，多层闭合通常涉及使用血管化的带蒂粘膜瓣。采用该技术已将我们的术后CSF泄漏率从5.9％降低到3.1％。
结论：在过去的十年中，内窥镜鼻内修复脑脊液漏和脑囊肿有了显著的发展。通过四个鼻内通道的不同内窥镜方法的多功能性允许内窥镜修复几乎所有颅底缺损。作为多层闭合策略的一部分，血管化带蒂粘膜瓣的使用已经发展成为覆盖这些缺陷的一部分。
