经蝶腔手术治疗垂体腺瘤蛛网膜脱垂无瓣重建术

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-09-30 DOI:10.1016/j.clineuro.2025.109178

Mariano Montes de Oca-Delgado , Jaime Jesús Martínez-Anda , Gerardo Guinto-Balanzar , Juan Luis Gómez-Amador , Abraham Gallegos-Pedraza , Carolina de la Llata-Segura , Ildefonso Muñoz-Romero , Pablo David Guerrero-Suárez

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引用次数: 0

摘要

背景：经蝶窦手术后有效的垂体窝重建对于预防术后脑脊液（CSF）泄漏和空蝶鞍综合征至关重要。因此，减少蛛网膜脱垂进入蝶窦是必要的，以避免这些和其他并发症。目的探讨蛛网膜脱垂进入蝶窦的相关因素。作为次要目的，我们提出了一种新的无皮瓣重建技术，并证明了其避免术后脑脊液泄漏的有效性。方法对蛛网膜脱垂患者和非蛛网膜脱垂患者进行病例对照研究。我们分析了一种新型蛛网膜脱垂的临床和手术结果，包括可吸收氧化纤维素材料复位技术和无皮瓣多层重建，经蝶窦内镜手术治疗垂体腺瘤的患者。结果2014年1月至2024年12月共纳入105例患者。术中，71.4% %的病例肿瘤粘连较软；45.8% %的患者发生蛛网膜脱垂，3.8% %的患者发生术后脑脊液漏。与蛛网膜脱垂相关的因素有：肿瘤切除技术、鞍膈（DS）面积、大体全切除及软瘤一致性。结论经蝶腔手术中发现蛛网膜脱垂最重要的因素是蛛网膜的完整。如果满足这个条件，上述所有因素都与脱垂的发展有关。使用可吸收氧化纤维素的无瓣重建技术用于蛛网膜脱垂复位，是一种安全有效的鼻中隔瓣替代技术，可提供类似的术后并发症保护，显著减少鼻窦并发症。

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Arachnoid prolapse reduction with flapless reconstruction technique in pituitary adenomas treated with endoscopic transsphenoidal surgery

Background

Effective reconstruction of the pituitary fossa following, transsphenoidal surgery is critical in the prevention of postoperative cerebrospinal fluid, (CSF) leaks and empty sella syndrome. Therefore, reducing arachnoid prolapse into, the sphenoidal sinus is essential to avoid these and other complications.

Objective

This study aims to identify factors that are related to arachnoid prolapse into the sphenoidal sinus. As secondary objective we propose a novel flapless reconstruction technique and prove its effectiveness in avoiding postoperative CSF leak.

Methods

A case-control study was conducted including patients with and without arachnoid prolapse. We analyzed the clinical and surgical results of a novel arachnoid prolapse involving reduction technique with resorbable oxidized cellulose material and flapless multilayer reconstruction in patients surgically treated by transsphenoidal endoscopic surgery with diagnosis of pituitary adenoma.

Results

Between January 2014 and December 2024, 105 patients were included in this study. Intraoperatively, tumor consistency was soft in 71.4 % of cases; arachnoid prolapse occurred in 45.8 % of patients, and 3.8 % developed postoperative CSF leak. Factors related to arachnoid prolapse were tumor resection technique, wider diaphragma sellae (DS) area, gross total resection and soft tumor consistency.

Conclusions

The most important factor to found arachnoid prolapse during endoscopic transsphenoidal surgery is to have intact arachnoid membrane. If this condition is fulfilled, all the previously mentioned factors are related to the development of the prolapse. Flapless reconstruction technique for arachnoid prolapse reduction using resorbable oxidized cellulose, is a safe and effective alternative to nasoseptal flaps, offering comparable protection against postoperative complications with significantly fewer sinonasal complications.

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.