Through the nostrils, a hole of only 2 square centimeters is drilled at the base of the skull to perform surgery on serious diseases such as intracranial tumors and trauma. This technique is already a leader in neurosurgery. The 2 square centimeter hole is not drilled, cut down, and then “completed back to Zhao” after the operation is completed. The micro-engraving technique on the skull is considered by the endoscopic skull base professionals worldwide as an “impossible task.
However, this technology was pioneered and implemented by Chinese doctors and became a new surgical procedure named by the Chinese.

On February 13-17, the annual meeting of the American Society of Skull Base Surgery (NASBS), the world's leading academic organization for endoscopic skull base, was held in Orlando, Florida, USA. Dr. Yang Gang, the director of neurosurgery from the First Affiliated Hospital of Chongqing Medical University, showed off his “In Situ Bone Flap” technology and shocked the professionals present.
This is the first time in the world to propose an in situ bone flap. This technique also avoids cerebrospinal fluid leakage and intracranial infection caused by repair of fat, muscle, fascia, nasal mucosa and other bone tissues.
Minimally invasive surgery requires drilling the skull base
Make up the hole into a puzzle
The skull base is under the skull, supporting the brain, cerebellum and brain stem. It consists of the frontal, butterfly, sputum, sieve and occipital bone. The special sensory organs of sight, hearing and smell are located in it. Twelve pairs of cranial nerves and The arteries and veins of the brain are supplied from the base of the skull, and the anatomy is complicated, and many important structures cannot be damaged. Various diseases such as tumors, inflammation, trauma and deformity in this area are the main targets of surgical research and treatment of skull base surgery.
The world's top endoscopic skull base professional academic organization - "North American Cranial Surgery Association" invented neuroendoscopic transnasal skull base surgery. Because the surgical trauma is minimal, and there is no surgical incision on the head and face, the postoperative recovery is fast, so it is very popular with patients, greatly subverting the traditional craniotomy. After 2000, the technology was gradually introduced to China.
Endoscopic transsphenoidal surgery requires the skull base to be pierced. At present, the international practice is to use a high-speed grinding drill to "crush" the local skull base to form a bone window, and then enter the intracranial various surgical areas to remove the tumor.
However, the cranial fluid is filled with cerebrospinal fluid. After the operation is completed, the "cleft hole" of the skull base that has been drilled by the surgical approach must be repaired, otherwise the cerebrospinal fluid leakage will occur. For decades, doctors in cranial surgery in various countries have repeatedly stayed in the "membranous repair" of skull base with various fats, muscles, fascia and nasal mucosa. A few experts use bone tissue from other parts of the body to repair. However, there is still a 10-15% chance of cerebrospinal fluid leakage and consequent severe intracranial infection.
Complete the "impossible task"
Reduce the incidence of minimally invasive surgery after skull base
How to avoid cerebrospinal fluid leakage and intracranial infection caused by other tissues? Yang Gang, who has done skull surgery for more than 20 years, has been thinking.
Can you use your own bones, just like a craniotomy, do the bone flap first, and then repair it after surgery? But this technology is not unexpected, but it is difficult to do. This is why no one has ever published it at an international conference since the establishment of the endoscopic skull base surgery profession.
To make a complete bone flap on the skull base with a rich and important vascular nerve, it is not only comparable to the technique of micro-carving, but also carries a huge risk.
Yang Gang needs to use a very small high-speed grinding drill to grind a complete bone flap of about 1x2cm in the skull base surgery area, and then enter the brain to remove the tumor.
The blue circle in the figure below is the scope of surgery that needs to be opened. It is a narrow area densely covered by blood vessels (bilateral carotid artery, cavernous sinus) and nerve (bilateral optic nerve), and it is uneven (optical canal, internal carotid artery bulge) , saddle nodules, slope crypts, etc.).
The skull base is thick and uneven, and the local area is as thin as a flap, and some places are firm and firm. Moreover, the above-mentioned nerves and blood vessels are interspersed in the bone, and a slight deviation in the bone flap can lead to catastrophic consequences.
What's more: all of this is done through a pipe about 8cm long in the nostrils (about 1cm in diameter)!
After grinding the bone flap, opening the dura mater, and successfully removing the large intracranial tumor, the bone flap is returned to the original subject. This is an "impossible task", but it tries to ensure the structure of the skull base. Integrity greatly reduces the risk of postoperative cerebrospinal fluid leakage and intracranial infection.
Yang Gang said that as early as a few years ago, the team began to try to use the in situ bone flap for skull base repair surgery. At first, it is not an easy task, because there is no experience to learn from, no literature to refer to, because no one has reported it! But he is a person who is particularly brave enough to face challenges and pursue endless.
After years of research, I finally developed this magical skill. At present, the Yang Gang team has successfully completed dozens of such operations. Because of the “anatomical reduction” in the true sense, cerebrospinal fluid leakage rarely occurs after surgery. Related SCI articles have been and are being published.