中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (16): 2580-2586.doi: 10.12307/2023.172

• 生物材料综述 biomaterial review • 上一篇    下一篇

颅底重建的修补材料选择及生物学特性

怀  鹏1，张翼鹏2，王  溪1，王  维1，王  亮1，陈  镭1   

  1. 1天津第五中心医院神经外科，天津市  300450；2 北大医疗海洋石油医院病理科，天津市  300452
  • 收稿日期:2022-03-16 接受日期:2022-06-18 出版日期:2023-06-08 发布日期:2022-11-11
  • 通讯作者: 陈镭，医学博士，主任医师，科主任，天津第五中心医院神经外科，天津市 300450
  • 作者简介:怀鹏，男，1979年生，汉族，2008年天津医科大学研究生院(神经外科专业)毕业，医学硕士。

Selection and biological characteristics of repair materials for skull base reconstruction

Huai Peng1, Zhang Yipeng2, Wang Xi1, Wang Wei1, Wang Liang1, Chen Lei1   

  1. 1Department of Neurosurgery, Tianjin Fifth Central Hospital, Tianjin 300450, China; 2Department of Pathology, PKUCare CNOOC Hospital, Tianjin 300452, China
  • Received:2022-03-16 Accepted:2022-06-18 Online:2023-06-08 Published:2022-11-11
  • Contact: Chen Lei, MD, Chief physician, Department of Neurosurgery, Tianjin Fifth Central Hospital, Tianjin 300450, China
  • About author:Huai Peng, Master, Department of Neurosurgery, Tianjin Fifth Central Hospital, Tianjin 300450, China

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摘要：


文题释义：

3N原则：指颅底修补过程中遵循的原则：①修补使颅内外由开放变闭合(NO water)；②各层不能有间隙(NO gaps)；③材料平整，清除黏膜、骨嵴(NO encumbrance)。
带蒂黏膜瓣：带蒂其血供源于蝶腭动脉的鼻中隔支黏膜瓣往往延展性较好，根据颅底缺损需要可修剪成不同的大小和形状，其优点是修补后的带蒂黏膜瓣因为带有血供，会与颅底蝶窦黏膜生长为一体，达到修补效果最大化，带蒂黏膜瓣边缘要求与鞍底紧密贴附，不留空隙，有助于黏膜生长。

背景：神经内镜经鼻蝶手术因其微创、显露充分、术后恢复快等特点，已成为前颅底中线及侧颅底占位最常用的手术方式。随着手术范围及适应证也的不断扩展，颅底磨除范围相应增加，这也使术后脑脊液漏发生率也相应增高。严重的脑脊液漏可导致患者致命性的颅内感染及极差的预后。因此在神经内镜手术后，可靠的颅底重建是手术成功的基本条件，文章以此对颅底重建原则、方法、颅底重建应用的不同材料的生物学特性等展开综述。
目的：阐述颅底重建的原则方法，总结不同重建材料的研究进展及不同生物学特性在颅底重建中的作用。
方法：计算机检索万方及PubMed数据库2012年1月至2022年1月收录的文献，中文检索词为“颅底重建、神经内镜、颅底骨缺损、经鼻蝶手术入路、多重修补、带蒂黏膜瓣、聚醚醚酮、羟基磷灰石”，英文检索词为“Skull base reconstruction，Neuroendoscopy，Skull base bone defect，Transnasal-sphenoidal operative approach，Multiple repair，Pedicled mucosal flap，Polyether-ether-ketone(PEEK)，Hydroxylapatite”，最终纳入60篇文献进行综述。
结果与结论：①神经内镜经鼻蝶术后，即使颅底缺损越来越大，颅底重建的目地依旧是预防脑脊液漏避免严重并发症，目前多层修补是一致认可的修复原则。②骨性支撑的类骨材料诸如聚醚醚酮、羟基磷灰石因为价格昂贵且术前准备繁琐，临床应用较少；临床医生多靠类硬膜结构的生物材料及带蒂黏膜瓣完成修补，但受限于修补支撑力弱及黏膜瓣血运情况，少数病患仍有一定概率存在脑脊液漏的风险。③因此，术中类硬膜、类骨结构人工生物材料以及带蒂黏膜瓣修补颅底缺损符合恢复颅底的解剖修复，有助于硬膜、骨质结构的再生，这样也使疏水组织-类硬膜结构-类骨结构-黏膜的一体化生物材料研发具有广阔的应用前景。
https://orcid.org/0000-0003-2562-9211(怀鹏)；https://orcid.org/0000-0003-1765-9816(陈镭)
中国组织工程研究杂志出版内容重点：生物材料；骨生物材料；口腔生物材料；纳米材料；缓释材料；材料相容性；组织工程

关键词: 颅底重建, 神经内镜, 颅底骨缺损, 经鼻蝶手术入路, 多重修补, 带蒂黏膜瓣, 聚醚醚酮, 羟基磷灰石

Abstract: BACKGROUND: Transnasal-sphenoidal neuroendoscopic surgery has become the most common surgical method for anterior skull base midline and lateral skull base location due to its characteristics of minimal invasion, full exposure and quick recovery. With the continuous expansion of surgical indications, the scope of skull base opening becomes larger and larger, then the incidence of postoperative cerebrospinal fluid leakage is correspondingly increasing. Severe cerebrospinal fluid leakage can cause fatal intracranial infection. Therefore, after neuroendoscopic resection of tumors, reliable skull base reconstruction is an essential condition for successful surgery. In this paper, the principles and methods of skull base reconstruction and biological properties of different materials used in skull base reconstruction are reviewed.
OBJECTIVE: To expound the principles and methods of skull base reconstruction, summarize the research progress of different reconstruction materials and the role of different biological characteristics in skull base reconstruction.
METHODS: Articles were retrieved on Wanfang and PubMed databases published from January 2012 to January 2022. The Chinese and English search terms were “skull base reconstruction, neuroendoscopy, skull base bone defect, transnasal-sphenoidal operative approach, multiple repair, pedicled mucosal flap, polyether-ether-ketone (PEEK), hydroxylapatite”. Finally, 60 articles were included for review. 
RESULTS AND CONCLUSION: (1) Even if the skull base defect is getting bigger and bigger, the purpose of skull base reconstruction is still to prevent cerebrospinal fluid leakage and avoid serious complications after transnasal-sphenoidal neuroendoscopic surgery. Multilayer repair is a universally accepted principle. (2) Bone-like materials such as polyether-ether-ketone and hydroxylapatite for bony support are less clinically used because of their high price and cumbersome preoperative preparation. Clinicians mostly rely on dural-like biomaterials and pedicled mucosal flaps to complete the repair. However, limited by the weak repair support and the blood supply of the mucosal flap, a small number of patients still have a certain risk of cerebrospinal fluid leakage. (3) Therefore, intraoperative dura-like and bone-like structure artificial biomaterials and pedicled mucosal flaps to repair skull base defects are in line with the restoration of the anatomical repair of the skull base, and are helpful for the regeneration of the dura and bone structures. The research and development of biomaterials integrating hydrophobic tissue + dural-like mater + bone-like structure + mucosa have great prospects for skull base reconstruction.  

Key words: skull base reconstruction, neuroendoscopy, skull base bone defect, transnasal -sphenoidal operative approach, multiple repair, pedicled mucosal flap, polyether-ether-ketone, hydroxylapatite

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