硬膜内病变经鼻内镜手术后脑脊液漏的预防

IF 3.3 2区 医学 Q2 CLINICAL NEUROLOGY
Harisinh Parmar, Hirotaka Hasegawa, Yuki Shinya, Motoyuki Umekawa, Hironobu Nishijima, Kenji Kondo, Hideaki Ono, Shunya Hanakita, Nobuhito Saito
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引用次数: 0

摘要

目的:本研究的目的是评估水密硬脑膜封闭术(WTDC)在防止颅底肿瘤扩大内镜经鼻手术(ETS)术后脑脊液漏的疗效,同时避免常规鼻中隔皮瓣的使用,保持鼻窦质量。方法:这项回顾性研究包括28例在2022年6月至2024年6月期间在一家机构接受ETS并经历Esposito 3级脑脊液漏的患者。WTDC采用阔筋膜移植和各种缝合技术。回顾手术录像和电子病历以评估缝合时间和术后结果。评价了WTDC预防脑脊液渗漏的效果,并分析了该手术的技术方面。结果:28例患者(女14例,男14例)中,14例成功完成WTDC,其余14例接近水密闭合。平均缝合时间随经验的增加而减少,呈现效率提高的趋势。术后无脑脊液渗漏,1例术后脑膜炎痊愈,无后遗症。尽管存在脑脊液漏的显著危险因素,WTDC在所有没有常规腰椎引流的患者中都是有效的。结论:在有高危因素的复杂颅底手术中,腹腔灌流是预防术后脑脊液漏的可靠方法。该技术避免了使用鼻中隔瓣的并发症,保留了鼻窦的质量,减少了腰椎引流的需要,使其成为颅底重建的一个有价值的选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Contribution of watertight dural closure to prevention of postoperative cerebrospinal fluid leakage in endoscopic transnasal surgery for intradural lesions.

Objective: The goal of this study was to evaluate the efficacy of watertight dural closure (WTDC) in preventing postoperative CSF leakage during extended endoscopic transnasal surgery (ETS) for skull base tumors, while preserving sinonasal quality by omitting the routine use of a nasoseptal flap.

Methods: This retrospective study included 28 patients who underwent ETS and experienced Esposito grade 3 CSF leakage at a single institution between June 2022 and June 2024. WTDC was performed using fascia lata grafts and various suturing techniques. Surgical videos and electronic medical records were reviewed to assess suturing times and postoperative outcomes. The efficacy of WTDC in preventing CSF leakage was evaluated, and the technical aspects of the procedure were analyzed.

Results: Among the 28 patients (14 female, 14 male), WTDC was successfully achieved in 14 cases, with near-watertight closure in the remaining 14. The average suturing time decreased with experience, showing a trend of improved efficiency. No postoperative CSF leaks were observed, and 1 case of postoperative meningitis resolved without sequelae. Despite significant risk factors for CSF leakage, WTDC was effective in all patients without the routine use of lumbar drainage.

Conclusions: WTDC in ETS is a reliable method for preventing postoperative CSF leakage, particularly in complex skull base surgeries with high-risk factors. This technique avoids the complications associated with nasoseptal flap use, preserves sinonasal quality, and reduces the need for lumbar drainage, making it a valuable option for skull base reconstruction.

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来源期刊
Neurosurgical focus
Neurosurgical focus CLINICAL NEUROLOGY-SURGERY
CiteScore
6.30
自引率
0.00%
发文量
261
审稿时长
3 months
期刊介绍: Information not localized
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