Spontaneous CSF Rhinorrhea Our Experience

Cerebrospinal fluid (CSF) leak occurs due to an abnormal communication between the subarachnoid space and sinonasal tract. We reported a retrospective case series of five patients of spontaneous CSF rhinorrhea. These patients were undergone successful repair with a single transnasal endoscopic procedure. This is seen in anterior part of the cribriform plate of middle aged obese females. HRCT paranasal sinus (1 mm cuts) was an effective modality of investigation in our study with ancillary investigations been CT cisternography. Endoscopic repair of CSF rhinorrhea carries a high success rate with very low morbidity rate.     

Endoscopic Repair of Lateral Sphenoid Recess Cerebrospinal Fluid Leaks

Endoscopic repair of anterior cranial base has been widely reported. However there is still no uniformity in the technique of endoscopic repair of lateral sphenoid cerebrospinal fluid (CSF) leaks. To highlight the management of CSF leak or encephalocele in the lateral sphenoid recess and relate our experiences. We retrospectively reviewed the medical records of all our patients who underwent an endoscopic repair of CSF leaks in the lateral sphenoid recess during the period from September 2003 to January 2010 at our tertiary hospital. Fifteen cases with CSF leaks/encephalocele that were repaired by the endoscopic approach were included. The majority of our cases were spontaneous leaks. In all our cases we approached the site of defect by an end on approach. All our patients were successfully treated in the first attempt. Endoscopic repair of lateral sphenoid recess has shown better surgical outcome with reduced morbidity.     

Cerebrospinal fluid rhinorrhea: endoscopic repair based on a combined diagnostic approach

Background

The treatment of cerebrospinal fluid rhinorrhea has evolved since the first recorded instance of this condition by Willis in 1676. The advancements in radiology and endoscopic nasal surgery have provided ways to solve this potentially dangerous condition. But even now quite a few questions remain unanswered while tackling this difficult clinical situation. Laboratory tests for confirming the presence of cerebrospinal fluid in nasal fluid can yield false positive results and radiological evaluation has never been foolproof when it comes to small leaks and multiple leaks. Also the postoperative recurrence needs to be brought within acceptable limits.

Objectives

We have tried to evaluate endoscopic repair of CSF rhinorrhea based on a combined diagnostic approach. The methods for diagnosis of CSF rhinorrhea have been reevaluated based on our experience with a view to prevent recurrences and complications.

Materials and methods

The study group included twenty patients of CSF rhinorrhea who have been treated by endoscopic repair and spans over a period of five years from January 2001 to December 2005. A combination of retrospective and prospective methods of study has been used. Patients have been subjected to laboratory, radiological and dye studies for confirmation and localization of leak. Endoscopic repair of CSF fistula with composite graft and fibrin glue has been performed. Postoperative management included intracranial pressure reducing measures and control of primary condition in cases of spontaneous leak.

Results

Endoscopic repair of CSF rhinorrhea produced a first time success rate of 92%. CT/MR Cisternogram could localize the defect in 85% cases while intrathecal fluorescein aided localization whenever it was used. The use of fibrin glue with composite graft and postoperative intracranial pressure reducing measures could improve the success rate.

Conclusion

Management of a suspected CSF leak requires a combined diagnostic approach. Endoscopic repair with composite graft and fibrin glue should be the first line of management in cases of CSF rhinorrhea requiring surgical closure. Intracranial pressure reducing measures play an important role in preventing postoperative recurrence.     

A Comparitive Study of Endoscopic Skull Base Reconstruction in CSF rhinorrea using Nasoseptal Flap with Septal Cartilage v/s Fascia Lata With Fat

The objective of the study is to evaluate the surgical outcome between free nasoseptal mucoperichondrial flap using septal cartilage vs fascia lata using fat in terms of morbidity, hospital stay and postoperative complications. It is a retrospective comparitive study of 127 patients, diagnosed with CSF leak and who underwent repair of anterior skull base defect using free nasoseptal mucoperichondrial graft with septal cartilage in 73 cases compared with fascia lata with fat in 54 cases over the time frame of 5 years. The success rate with free nasoseptal flap with septal cartilage was 97.3% and that with fascia lata with fat was 96.3%. There was a significant association between mean hospital stay and the technique of CSF repair (unpaired t test, p −0.02). In our study the complications following the repair with free nasoseptal flap with septal cartilage was significantly less (p < 0.05, chi square test). The above study concludes that in patients treated with free nasoseptal flap using septal cartilage has less hospital stay, less post-operative morbidity in the form of pain, movement and dependence for cleaning and dressing in comparison to fascia lata using fat.     

Spontaneous Medial Cribriform CSF Leak: Endoscopic Surgical Repair with Free Mucosal Graft—Our Experience

Cribriform plate is the commonest site of spontaneous CSF leak, the fragility of the plate and juxtaposition of arachnoid’s investment to the bone, where the olfactory nerve pierces the skull made this area, a vulnerable site for CSF leak. Transnasal endoscopic approach has gained popularity for CSF leak repair over the years. To describe the 5 year experience of spontaneous medial cribriform CSF leak repair with free mucosal graft in a tertiary medical centre. All patients who underwent transnasal endoscopic repair with free mucosal graft for spontaneous medial cribriform CSF leak in our institution between 2011 and 2016 were reviewed. Twelve patients were identified, all were women with a mean age of 44.5 years. The defect was localised by preoperative computed tomography scans with 1 mm cuts and MR cisternography. Via medial approach, the mucosa surrounding the entire defect was denuded and the defect was closed with free mucosal graft harvested either from the middle turbinate or from the nasal septum and middle turbinate was finally sutured with septum to stabilise the repair. The overall success rate was 100% with the first attempt with no recurrence or postoperative complications. Follow up ranged from 1 to 5 years. The endoscopic transnasal technique with free mucosal graft for the repair of spontaneous medial cribriform CSF rhinorrhoea is associated with a very high success rate and it should be considered for majority of cases.     

Spinal111Indium-DTPA CSF flow studies in leptomeningeal metastasis

Sixteen consecutive patients (8 men; 8 women; age range 6–63 years, median 40 years) with leptomeningeal metastasis were found by radionuclide ventriculography to have cerebrospinal fluid (CSF) flow interruption at the following sites: cisterna magna/basal cisterns (6); cervical (5) and thoracic (3) spinal subarachnoid space. Two additional patients had no evidence of interruption of CSF flow. All patients underwent intralumbar injection of¹¹¹Indium-DTPA and imaging of spinal ascent of radionuclide, corroborating sites of CSF flow disruption seen by radionuclide ventricuiography. Median (range) time to appearance in lumbar, thoracic and cervical spinal subarachnoid compartments were 1 (1), 22.5 (20–25) and 32.5 (30–35) minutes respectively. Appearance of radionuclide in the cisterna magna/basal cisterns, sylvian cisterns, ventricular system and high cerebral convexity was 37.5 (35–40), 65 (60–70), 1440 (1440) and 1440 (1440) minutes respectively. Only 1 of 8 patients with interruption of CSF flow within the spinal subarachnoid space shown by intralumbar radionuclide flow study, was seen by either CT myelography or contrast enhanced spine MR to have CSF flow block. No patient with base of brain block (0/6) shown by radionuclide CSF flow studies demonstrated CSF flow disruption by either cranial contrast enhanced CT or MR. In conclusion, spinal¹¹¹In-DTPA CSF flow studies confirmed sites of CSF flow block shown by radionuclide ventriculography and demonstrate the feasibility of assessing CSF compartmentalization by intralumbar radionuclide administration. Furthermore, radionuclide CSF flow studies when compared to conventional neuroradiographic imaging are more sensitive in demonstrating interruption of CSF flow.     

Cribriform CSF Leak: Endoscopic Surgical Repair Using Free Septal Mucosal Graft Without Postoperative Nasal Packs

Cribriform plate is the commonest site of Cerebrospinal fluid (CSF) leak, its fragility and juxtaposition of arachnoid’s investment to the bone, where the olfactory nerve pierces the skull, is a vulnerable site for CSF leak. Endoscopic transnasal approach has been the main stay for CSF leak repair over the past 2 decades. The technique and surgical steps of Endoscopic Surgical Repair of Cribriform CSF Leak using Free Septal Mucosal Graft without Postoperative Nasal packs are presented. Transnasal endoscopic CSF leak repair under General anesthesia with free mucosal graft, the critical steps include visualize the site of leak, lateralisation of middle turbinate, defect site cauterised with bipolar cautery. Free mucosal from contralateral side of the septum was placed as overlay technique. Graft stabilised with surgicel after ensuring adequate contact between the graft and the defect site. If the defect site is large then fat harvested from thigh is used as bath plug the defect, then free mucosal graft is kept supported by surgicel. Finally the middle turbinate was medialized and sutured with 3 0′ Vicryl with nasal septum to support the graft and also to stabilize the middle turbinate as a quilting stich. No fibrin glue was used in our case series. No nasal packing was done. Patients discharged on 2nd or 3rd postoperative day. This technique provides consistent good results reduced operating time of 40 min, no post-operative morbidity, early mobilisation, with 100% success rate and with added advantage of no nasal packing, patient can easily breathing through the nose postoperatively & no recurrence on long follow up.Electronic supplementary materialThe online version of this article (doi:10.1007/s12070-020-02107-1) contains supplementary material, which is available to authorized users.     

Cerebrospinal fluid rhinorrhoea—Transnasal endoscopic repair

The recent advances in nasal endoscopic surgery in anterior skull base area have made it the procedure of choice for repair of cerebrospinal fluid rhinorrhoea (CSFR). The aim of the present study is to analyze the technique and efficacy of endoscopic repair of CSFR.     

Endoscopic Modified Danker’s Approach for Management of Sinonasal Inverted Papilloma: Our Experience

Sinonasal inverted papilloma (SNIP), Inverting papilloma, Schneiderian papilloma etc. It is a benign tumor with incidence nearly 70% of all sinonasal papilloma and 0.5–4.0% of all sinonasal neoplasms. The most common site of origin is lateral nasal wall and common presenting symptom is nasal obstruction followed by epistaxis. On histopathology examination, it is characterized by invagination of neoplastic epithelium into underlying stroma. With the advent of technology, the endoscopic modified dankers approach became the surgical approach of choice. The present study was undertaken to study its role in management of SNIP with reference to rate of recurrence and malignancy. An observational study was conducted in a tertiary health center in which 40 biopsy proven cases of SNIP, operated by endoscopic assisted modified Danker’s approach between September 2008 and January 2019 with minimum follow-up period of 6 months were analyzed. Male:Female ratio was 2.33:1. The most common symptom was nasal obstruction (97.5%) followed by rhinorrhoea (87.5%). Using various imaging and diagnostic measures, lateral nasal wall was found to be the most common site of origin. Out of total 40 cases, 9 (27.5%) patients had recurrence, of these, 6 were benign and remaining 3 had malignancy as confirmed by biopsy. Most of the cases of SNIP can be managed endoscopically, although extensive lesions or the lesions with malignant transformation, external approach may be needed so expertise in both endoscopic and conventional techniques is needed. Although most of the recurrences occurred in first 2 years, but life time follow-up is advisable.     

Endoscopic repair of cerebrospinal fluid rhinorrhea — Manipal experience

Otolaryngologists play a major role in the management of cerebrospinal fluid (CSF) rhinorrhea. A thorough understanding of the underlying pathophysiology and the various treatment options available is essential to achieve the best possible results. In this paper, we are highlighting the pathophysiology, diagnosis and surgical technique involved in the repair of cerebrospinal fluid rhinorrhea. A retrospective study conducted in the department of ENT and Head and Neck Surgery, Kasturba Hospital, Manipal is presented to highlight our experience with cerebrospinal fluid rhinorrhea. Eleven patients were managed in the department of otolaryngology between 1999 and 2005. Seven had spontaneous CSF rhinorrhea, three were due to trauma and one iatrogenic, following surgery. Commonest anatomic site of leak was the cribriform plate in 4 cases. Other sites included sphenoid [2], lateral lamella [2], fovea ethmoidalis [2] and olfactory groove [1]. Onlay technique was performed in 10 out of 11 patients. Closure was successful in 10 out of 11 cases in the first attempt. One patient underwent revision surgery. Patients were followed up for a period ranging from 3 months to 3 years. CSF rhinorrhea is a potentially fatal condition which requires precise and urgent treatment. The transnasal endoscopic repair of CSF leak has a high success rate with low morbidity when performed by experienced endoscopic sinus surgeons. Our experience in managing this condition is presented.     

Endoscopic Septoplasty: A Retrospective Analysis of 415 Cases

Nasal obstruction is the most common complaint in nasal and sinus disease. Deviated nasal septum is a very frequently encountered and common cause. Surgical correction of a deviated septum- nasal septoplasty- is the definite treatment for septal deviation. Over the last 2 decades, the applications for endoscopy in the field of rhinology have evolved beyond functional endoscopic sinus surgery (FESS). Septoplasty which is among the three most commonly performed procedures in otolaryngology is particularly well suited to endoscopic application. Endoscopic septoplasty as a minimally invasive technique can limit the dissection and minimize trauma to the nasal septal flap under excellent visualization whose primary advantage is to decrease morbidity and post operative swelling in isolated septal deviation by limiting the excision to the area of deviation. This was a retrospective study, conducted in a tertiary care medical college hospital over a period of 5 years. The study group comprised 415 patients in and around Nashik District; who visited our tertiary health centre and were subjected to endoscopic septoplasty. Complete data records from 415 patients were available for statistical analysis. Maximum numbers of patients were in age group 20–39. The youngest patient was 7 years old and oldest was 75 years. Mean age was 32 years. The 7 years old was operated for DCR for congenital NLD block and septoplasty was adjunct procedure. Even the 75 years was operated for DCR. In the present study out of 415 cases, 256 (67.5 %) cases were male and 115 (32.5 %) cases were female. There is a male preponderance in the overall distribution of cases. In the present study of 415 patients, the most common operative procedure done was septoplasty in 260 (62.6 %), FESS with septoplasty in 38 (9.2 %) cases, septorhinopolasty in 41 (9.9 %) cases and DCR with septoplasty in 78 (18.3 %) cases. Endoscopic septoplasty facilitates good access to accomplish endoscopic DCR, FESS, and accurate and adequate septal graft harvest in severely deviated noses for septorhinoplasty. Complications like dental pain, paraestaesia, septal perforation, saddle nose deformity and persistent deviation are a rarity.     

Natural Orifice Endoscopic Thyroidectomy via Transoral Vestibular Approach (TOVA): Single Surgeon Experience from North India

The transoral vestibular approach (TOVA) is the shortest route for endoscopic thyroidectomy (ET) to approach the thyroid and is a totally scar free procedure, hence it has a clear cosmetic advantage not only over conventional open thyroid surgery but also over other remote access approaches for ET like axilla, breast and chest wall approaches. The aim of this study was to evaluate the feasibility, safety and our initial outcomes of TOVA and highlight the advantages of 3D endoscopic equipment in remote access thyroid surgery. We reviewed our prospectively maintained database who underwent ET. 42 patients who fulfilled the stringent inclusion criteria were offered TOVA. We have used novel Trans-vestibular approach with 3D technology for endoscopic thyroid surgery in all cases. Clinico-demographic profile, investigations, operative details, histopathology and postoperative complications and follow-up data were analyzed by using statistical analysis with SPSS19.00 version. Out of 203 ET operated during study period, 42 (20.69%) patients were operated through TOVA. Hemithyroidectomy were performed in all the patients. There were 3 men and 39 women (M:F = 1:13). Mean tumor size was 3.54 ± 1.17 cm. All patients were euthyroid. All patient had cytological diagnosis of Bethesda category II-IV and all underwent hemithyroidectomy. Mean operation time was 107.71 ± 17.60 min and post-operative length of hospital stay was 2.90 ± 1.28 days. Besides magnification, 3D endoscopy provided excellent depth perception which helped in precise dissection in the restricted space and aided in identification and preservation of the two most vital structures i.e. recurrent laryngeal nerve and parathyroid glands. As most of our patients present with larger goitres, not many patients desirous of ET can be offered TOVA. This novel TOVA has fairly stringent inclusion criteria, however it is the only approach which offers completely scarless endoscopic thyroidectomy and should be offered to eligible patients desirous of ET.     

Hyaluronan in the Treatment of Chronic Rhinosinusitis with Nasal Polyposis

Chronic rhinosinusitis (CRS) is a common condition and affects the quality of life of approximately 16 % of adults in US and 10.9 % in Europe. Hyaluronan (HA) is a nonsulphate glycosaminoglycan found in the extracellular matrix of connective tissues, and plays an important role in the healing process and repair of mucosal surfaces. We aim to evaluate the effect of HA on nasal symptoms and endoscopic appearance in patients with CRS and nasal polyps (NP) who have not undergone sinus surgery. Eighty patients older than 18 years old were randomized to receive either open-label nebulized saline solution (NS) or intranasal corticosteroid spray (ICS) 200 µg bid or nebulized sodium hyaluronate (NHA, YABRO^®) or both ICS and NHA. Results were collected at 1 month, 3 months and 3 months after treatment. Significant improvements in nasal symptoms scores, endoscopic appearance scores, radiologic scores, rhinomanometry and saccharine clearance test were observed in the NHA, ICS and ICS + NHA groups after 1 month and 3 months of treatment compared with baseline (all p ≤ 0.005). The use of oral steroids was significantly reduced after 3 months of therapy in the same groups versus baseline (all p < 0.05). The incidence of adverse events at 3 months was similar between the 4 groups (all p > 0.05). Throat irritation, nasal burning and drug-related epistaxis were not reported in the group NHA. HA, as a nebulized nasal douche preparation, improved nasal symptoms and endoscopic appearances in patients with CRS and NP who have not undergone sinus surgery.     

Pituitary tumors: our experience in the prevention of postoperative cerebrospinal fluid leaks after transsphenoidal surgery

The objective was to analyze the management of intraoperative CSF leaks in transsphenoidal surgeries to prevent postoperative cerebrospinal fluid (CSF) leaks. Sixty-three pituitary tumors were operated by transnasal approach. In presence of arachnoidal opening, a fat graft was placed into the sellar cavity, followed by collagen sponge layer and fibrin glue. The sphenoid sinus was also packed with fat graft and collagen sponge. An external CSF lumbar drainage was kept for 2–4 days. The variables analyzed were: intraoperative and postoperative CSF leaks, procedures, and related complications. The overall incidence of postoperative CSF leak was 1.5%. Twenty patients (31.7%) had intraoperative arachnoidal opening, 5% of whom had postoperative CSF leak. There were no reoperations because of CSF leak, and no secondary intrasellar arachnoidoceles. Mean follow-up was 3.6 years. The preventive treatment had good results and there were no complications related to the intervention strategy, encouraging us to continue performing this simple, effective, and inexpensive procedure.     

Next‐generation sequencing of endoscopically obtained tissues from patients with all stages of pancreatic cancer

Routinely available clinical samples of all stages of pancreatic cancer are used in the present study to elucidate its molecular mechanisms and identify novel therapeutic targets. We evaluated the use of next‐generation sequencing (NGS) of endoscopically obtained pancreatic cancer tissues. We enrolled 147 patients who underwent endoscopic ultrasound‐guided fine‐needle aspiration or endoscopic biopsy. The quantity and quality of the extracted DNA was assessed. Tissue samples were used for NGS of 78 cancer‐related genes, from which gene alterations and microsatellite instability (MSI) were extracted. NGS was successful in 141 out of 147 (96%) cases. Gene alterations were detected in 134 out of 141 (91%) samples, among which eight out of 10 samples with a DNA concentration below the detection limit had some type of gene alteration. Targetable genes were detected in 28 (19.9%) cases. MSI and germline mutations in homologous recombination repair associated genes were detected in 5% and 3% of cases, respectively. Cox regression analysis revealed that metastasis (P < .005; hazard ratio [HR], 3.30) was associated with poor prognosis in all pancreatic cancer patients. In addition, fewer than three mutations (P = .03; HR, 2.48) and serum carcinoembryonic antigen levels >5 ng/mL (P < .005; HR, 3.94) were associated with worse prognosis in cases without and with metastasis, respectively. Targeted sequencing of all stages of pancreatic cancer using available samples from real clinical practice could be used to determine the relationship between gene alterations and prognosis to help determine treatment choices.     

Extensive Allergic Fungal Rhinosinusitis: Ophthalmic and Skull Base Complications

To review the clinical features, ophthalmic and skull base complications, radiologic correlates, surgical methods and outcomes in cases of extensive allergic fungal rhinosinusitis (AFRS). The retrospective review was carried out at a tertiary referral center and included 11 patients with extensive AFRS. Inclusion criteria were confirmed cases of AFRS with intracranial extension, gross erosion of the skull base or medial orbital wall and/or ophthalmic complications of AFRS, including visual loss. Acute bacterial or invasive fungal sinusitis and other non-AFRS sinus pathologies with orbital or skull base complications were excluded from the study. The mean age of patients was 22.7 years. Proptosis was the most common presenting feature followed by diplopia and visual loss. Four patients exhibited unilateral visual loss with one case of sudden acute onset. Intracranial extradural spread to the middle cranial fossa was observed in two cases with cavernous sinus involvement, destruction of the entire cranial base and extension to the petrous temporal bone. Ten patients exhibited co-existing orbital and skull base erosion whereas gross erosion of the lamina papyracea alone was seen in one patient. All patients underwent endoscopic sinus surgery with complete disease clearance. The minimum and maximum follow-up periods were 1 and 3 years, respectively with one documented recurrence 18 months after surgery. Visual recovery was complete after sudden vision loss whereas it was only partial or absent in patients with prolonged vision loss. Cases of extensive AFRS with ophthalmic and skull base complications pose diagnostic and therapeutic challenges and merit early intervention with long-term follow-up.     

Selected ion monitoring technique for the evaluation of sterols in cerebrospinal fluid: a new approach to desmonsterol test for central nervous system tumors

Summary The desmosterol test for the diagnosis of central nervous system (CNS) tumors is proposed in a simplified form. The procedure is based upon the analysis of sterol profile in cerebrospinal fluid (CSF) by selected ion monitoring (SIM) technique. Applied to 55 patients with tumoral and non tumoral CNS disease, the new test detects average levels of CSF desmosterol in tumor bearing patients that are tenfold higher than in the absence of CNS neoplasia. On an individual basis, a concentration of CSF desmosterol equal to or higher than the mean plus twice the standard deviation for the reference group of patients with no CNS tumor, is considered a positive result. Based on this criterion, a correct diagnosis was made in 73% of cases vs 77% of the former test, which required a 5-day treatment period with a desmosterol-reductase inhibitor in order to increase CSF desmosterol concentration. With this revised procedure CSF desmosterol can be detected in smaller volumes of CSF without any drug pretreatment, thus making the test more suitable for clinical application.     

Comparison of Transoral/Transnasal Endoscopic-Guided Adenoidectomy with Endoscopic Nasopharyngeal Inspection at the End of Curettage Adenoidectomy

The purpose of this study was to evaluate the efficacy of transoral or transnasal endoscopic-guided adenoidectomy compared with endoscopic nasopharyngeal inspection at the end of curettage adenoidectomy. A prospective case series of patients who had adenoidectomy. A total of 27 girls and 34 boys (age range 2.5–18 years) in whom adenoidectomy with or without tonsillectomy procedure was planned were included in the study. The cases were divided into three groups. Group 1 Transoral endoscopic-guided adenoidectomy performed patients. Group 2 Transnasal endoscopic-guided adenoidectomy performed patients. Group 3 Transnasal endoscopic nasopharyngeal exploration performed at the end of the conventional curettage adenoidectomy. The study was completed on 61 children. Mean age and sex frequency were not significant different between the groups. Mean operative time were 11.6 ± 2.9, 15.6 ± 4.4 and 9.7 ± 2 min, respectively (p > 0.05). On the other hand, significant differences were observed in operative time between group 1 and group 2 (p < 0.05), and between group 2 and group 3 (p < 0.05). Transnasal endoscopic examination at the end of curettage adenoidectomy is an appropriate method to assess the residual adenoid tissue after conventional curettage adenoidectomy. Also, operative time of this method is shorter than transoral or transnasal endoscopic-guided adenoidectomy. We recommend transnasal endoscopic inspection in all patients after conventional curettage adenoidectomy.     

Gasket-Seal技术在颅底肿瘤内镜手术颅底重建中应用的荟萃分析

目的 评价Gasket-Seal技术在颅底肿瘤内镜手术颅底重建中应用的效果.方法 在中外文文献数据库中检索2007年10月至2016年10月已发表的关于应用Gasket-Seal技术进行颅底肿瘤内镜手术颅底重建的病例对照研究.利用Review Manager(5.3版)软件进行荟萃分析.结果 按文献入选标准共纳入5篇病例对照研究,共210例颅底肿瘤内镜手术患者纳入荟萃研究.荟萃分析表明,与非GS组相比,GS组患者术后远期脑脊液漏发生率低(OR=0.32,95％CI=0.11～0.89,P=0.03),术后脑膜炎发生率低(OR=0.10,95％CI=0.01～0.67,P=0.02).根据GS组是否联合NSF进行亚组分析,结果表明两亚组术后远期脑脊液漏发生率间比较,差异无统计学意义(P=0.85).在GS组中,采用人工骨组与采用同种骨(包括自体骨和异体骨)组病例术后脑脊液漏发生率比较,差异无统计学意义(P=0.25).结论 应用Gasket-Seal技术能安全有效地完成颅底肿瘤内镜手术中的颅底重建.相较其他颅底重建方法,术后脑脊液漏及脑膜炎的发生率更低.