Abstract：
Sellar reconstruction is important for preventing cerebrospinal fluid (CSF) leakage after transsphenoidal pituitary surgery. This report describes how, despite standard sellar reconstruction, CSF exudation resulted from dural thinning at the anterior skull base, outside the intrasellar area manipulated during pituitary tumor resection. A 76-year-old man underwent endoscopic transsphenoidal surgery for a pituitary tumor extending toward the anterior skull base. After opening the sellar floor, intractable bleeding from the anterior intercavernous sinus occurred during bone removal at the anterior skull base. Pseudocapsule-based extracapsular resection was completed after stopping the bleeding. On the 10th postoperative day, the patient developed CSF rhinorrhea complicated by marked pneumocephalus, and emergency endoscopic repair of the CSF leak was performed. CSF leakage originated from the thinned dura at the anterior skull base located outside the intrasellar area manipulated during tumor resection. The thinned dural area at the anterior skull base coincided with the site of intractable bleeding of the anterior intercavernous sinus during bone removal in tumor resection. The thinned anterior skull base dura was covered with fascia, overlaid with fat, and closed with the nasoseptal flap. Endoscopic CSF leak repair was successful. Severe damage to the anterior intercavernous sinus can cause extensive exposure of the single-layered inner meningeal dura, where thinning might result in CSF exudation. Therefore, use of autologous tissues to cover and reinforce the severely damaged area of the anterior intercavernous sinus might help prevent postoperative CSF exudation.
摘要：
鞍区重建对于预防经蝶入路垂体手术后脑脊液（CSF）泄漏很重要。本报告描述了如何，尽管标准的鞍区重建,前颅底硬脑膜变薄导致脑脊液渗出，在垂体瘤切除术期间操纵的鞍内区域之外。一名76岁的男子接受了内窥镜经蝶入路手术，治疗了向前颅底延伸的垂体肿瘤。打开塞勒斯地板后，在前颅底骨切除期间，海绵间窦前的顽固性出血发生。在止血后完成基于假胶囊的囊外切除术。术后第10天,患者出现脑脊液鼻漏并伴有明显的气颅，并对脑脊液漏进行了急诊内镜修复。CSF泄漏源于位于肿瘤切除过程中操纵的鞍内区域外部的前颅底薄硬脑膜。前颅底变薄的硬脑膜区域与肿瘤切除术中骨切除期间前海绵间窦的顽固性出血部位相吻合。变薄的前颅底硬脑膜被筋膜覆盖，覆盖着脂肪，用鼻中隔皮瓣闭合。内镜下脑脊液渗漏修复成功。前海绵间窦的严重损伤可导致单层内脑膜硬脑膜的广泛暴露，变薄可能导致脑脊液渗出。因此,使用自体组织覆盖和加强海绵窦前段严重受损区域可能有助于防止术后脑脊液渗出。
