神经内镜下经鼻-扩大蝶窦入路术后颅底重建(附20例分析)

目的探讨神经内镜下经鼻-扩大蝶窦入路术后的颅底重建技术。方法回顾性分析20例神经内镜下经鼻-扩大蝶窦入路术后的颅底重建经验。其中鞍结节脑膜瘤7例,颅咽管瘤3例,垂体腺瘤10例。在切除肿瘤后均采用人工硬脑膜-明胶海绵和生物胶-人工硬脑膜的"三明治"式方法,同时辅以球囊支持修补材料和持续腰池引流。结果1次手术修补成功15例,短暂性脑脊液鼻漏经保守治疗治愈3例,2例2次内镜下经鼻入路行颅底重建得以修复。术后随访6个月～4年,疗效满意。结论"三明治"式修补方法加球囊支撑和持续性腰池引流,可显著降低术后脑脊液鼻漏的发生,是神经内镜下经鼻-扩大蝶窦入路术后颅底重建的可靠技术。

Skull base reconstruction after neuroendoscopic surgery via endonasal expanded transsphenoidal approach: analysis of 20 cases

Objective To explore the reconstruction techniques for defects of skull base after neuroendoscopic surgery via endonasal expanded transsphenoidal approach.Methods The experience in skull base reconstruction of 20 patients undergoing neuroendoscopic surgery via endonasal expanded transsphenoidal approach were reviewed retrospectively.Of the 20 patients, there were 7 cases with tuberculum sellae meningiomas, 3 craniopharyngiomas and 10 pituitary adenomas."Sandwich" made up of synthetic dural substitute, gelatin sponge and protein glue-fascia was used to repair the defect following the tumor removal, with support of a balloon stent and continuous lumbar cerebrospinal fluid drainage.Results Fifteen patients were repaired successfully just one time, 3 suffering from transient cerebrospinal fluid rhinorrhea were cured by conservative therapy, and 2 suffering from cerebrospinal fluid rhinorrhea and(or) asymptomatical pneumocephalus were successfully repaired via endoscopic endonasal approach again.The patients were followed up from 6 months to 4 years, and all obtained satisfying results.Conclusion "Sandwich" with support of balloon stent and continuous lumbar cerebrospinal fluid diversion is a versatile and reliable reconstruction technique for defect of skull base after endoscopic surgery via endonasal expanded transsphenoidal approach can result in a significant decrease in the incidence of postoperative cerebrospinal fluid leaks.