Abstract：
The present study aimed to investigate outcomes following open surgery for extensive skull base ORN. Open surgery through a personalized sequential approach was employed to deal with five cases of extensive skull base ORN. Two patients with mild cases underwent regional debridement and sequestrectomy, and three patients with severe cases underwent extensive resection with reconstruction using free anterolateral thigh (ALT) flap. Biological glues and vascularized flaps were used for obturation of the skull base bony defect to prevent postoperative cerebrospinal fluid (CSF) leakage. The infections were controlled by antibiotic administrations which strictly followed the principles of antimicrobial stewardship (AMS). As results, both regional debridement plus sequestrectomy and extensive resection achieved satisfied outcomes in all patients. No severe complications and delayed hospitalization occurred. During the follow-up period (8-19 months), all patients were alive, pain free, without crusting or purulent discharge, and no sequestration or CSF leakage occurred. In conclusion, a personalized sequential approach including open surgery, pedicled/vascularized free flap reconstruction and AMS was advocated for patients with extensive skull base ORN.
摘要：
本研究旨在调查广泛颅底ORN开放手术后的结果。通过个性化顺序方法进行开放手术，以处理5例广泛的颅底ORN。2例轻症患者行区域清创术和隔离切除术，3例重症患者使用游离股前外侧（ALT）皮瓣进行了广泛切除和重建。使用生物胶和血管化皮瓣封闭颅底骨缺损，以防止术后脑脊液（CSF）泄漏。通过严格遵循抗菌药物管理（AMS）原则的抗生素管理来控制感染。作为结果，在所有患者中,区域性清创术加隔离切除术和广泛切除术均取得了满意的结局.无严重并发症及住院延迟。随访期间（8-19个月），所有的病人都活着,无痛,没有结皮或脓性分泌物，未发生封存或脑脊液渗漏。总之,个性化的顺序方法，包括开放手术，对于广泛的颅底ORN患者，提倡带蒂/血管化游离皮瓣重建和AMS。
