AIM OF THE STUDY

Analysis of anatomic variants of cranial base structures aimed at the detection of possible multiple defect patterns and their effects on surgical tactics or plasty quality.

PATIENTS AND METHODS

A retrospective craniometric analysis was conducted using the results of spiral computed tomography (CT) and CT cysternography in 43 patients with multiple cranial base defects treated surgically in NMRCN named after N.N. Burdenko in 2010—2020.

RESULTS

Multiple cranial base defects are divided into simultaneous and consecutive. Simultaneous defects are detected more often in craniocerebral injuries or after surgical interventions. Consecutive defects are spontaneous and related to increased cerebrospinal fluid pressure, metabolic disorders, osteoporosis of cranial base bones. With that, the thickness and density of cranial base bones is less in patients with consecutive patients; they also have a higher incidence of empty sella turcica, which again underlines the role of the aforementioned etiological factors in the disease pathogenesis. The risk of consecutive defects is higher in patients with the hyperpneumatic sphenoid sinus, characterized by the lateral recess and neurovascular protrusion.

CONCLUSIONS

To diagnose cranial base defects, high-resolution computed tomography (0.5—1.0 mm slices) is required; all suspicious and «weak» locations should also be revised during surgeries. It is feasible to use vascularized flaps in simultaneous defects located close to one another. If defects are remote, the selection of the plastic material depends on the location. To avoid the emergence of consecutive defects, one has to use methods decreasing the intracranial pressure, as well as to eliminate concomitant endocrine diseases and osteoporosis.