METHOD OF MULTILAYER PLASTY OF LARGE BONE DEFECTS OF THE MIDDLE CRANIAL FOSSA IN PATIENTS WITH MENINGOENCEPHALOCELE OF THE TEMPORAL BONE OF VARIOUS ETIOLOGY Russian patent published in 2021 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to otorhinolaryngology. Lumbar drainage is installed under general anesthesia. Then an incision is made behind the ear, which is continued in the region of the temporal bone. The mastoid process and the scales of the temporal bone are exposed. In the course of the operation, autotissue is taken - a fragment of the fascia of the temporal muscle and the autocartilage of the auricle. Antromastoidectomy is performed with a transmastoidal approach. Further, the hernial sac is separated from the surrounding tissues welded to it. The altered medulla along with the membranes is cut off. After that, the edges of the defect are leveled with a bur. According to the size of the defect, a graft is made from "Osteomatrix", formed in such a way that the area of one side is larger than the other, and the side with a smaller area completely repeats the shape of the defect. Then, using cutting and diamond burs, a quadrangular craniotomy is performed with the formation of a hole 4 × 5 cm in size so that the lower edge of the trepanation opening after craniotomy is 0.5 cm above the upper border of the bony part of the external auditory canal. The cut bone plate is placed in saline solution. Further, through the quadrangular trepanation hole with a spatula, the dura mater in the defect zone is pushed back approaching the defect from the side of the middle cranial fossa. Through this approach, a graft from the "Osteomatrix" is placed with the side with a smaller area facing directly to the defect. Then, epidurally, from the side of the middle cranial fossa, a leaf of the previously obtained autofascia is laid, the size of which is larger than the size of the defect. In addition, from the side of the mastoid cavity, the defect zone is covered with a plate of the previously obtained autocartilage with a size corresponding to the size of the defect. The defect area is then treated with a synthetic absorbable two-component dura mater sealant. On top of it, another fragment of autofascia is placed with dimensions exceeding the area of the bone defect. Then, plastic closure of the quadrangular trepanation opening of the middle cranial fossa is performed with an autobone plate, fixing it with catgut bone sutures. The tightness of the plastic defect for liquorrhea is checked. After that, the operating wound is sutured in layers.

EFFECT: method ensures a reliable closure of large, 10 mm or more, bone defects of the middle cranial fossa without the subsequent development of a relapse of liquorrhea and the formation of a hernial protrusion of the membranes and brain matter into the mastoid and tympanic cavities.

1 cl, 1 ex, 8 dwg