PDF(Pubmed)
Abstract：
Background Large pituitary adenoma often pushes the diaphragma sella and extends to the suprasellar compartment. The thinned out diaphragma may get opened during endonasal endoscopic surgery and pose high risk for cerebrospinal fluid (CSF) leak. Such larger defects are difficult to plug with fat graft that tends to slip in to the subarachnoid space. Here, we describe a unique technique of closure of diaphragma sella that augment repair of the skull base in such cases. Materials and Method The free edge of diaphragma sella was sutured with the anterior tuberculum sella dura in five cases of large pituitary adenoma that needed extra arachnoidal resection. Suturing was done with 6-0 prolene using endoscopic needle holder that converted a large diaphragm defect in to a smaller arachnoid rent and was easily plugged with fat graft. Result None of these patients had postoperative CSF leak. Conclusion Though technically difficult, direct repair of the diaphragma sella is possible. This augments the skull base reconstruct and effectively reduces the chances of postoperative CSF leak.
摘要：
背景大的垂体腺瘤通常会推动the膜并延伸到鞍上室。在鼻内镜手术期间，变薄的diaphragm肌可能会打开，并构成脑脊液（CSF）泄漏的高风险。这种较大的缺陷很难与倾向于滑入蛛网膜下腔的脂肪移植物堵塞。这里,我们描述了一种独特的闭合隔膜蝶鞍的技术，在这种情况下可以增强颅底的修复。材料与方法对5例需要蛛网膜外切除的大型垂体腺瘤，将蝶鞍游离边缘与硬膜前结节缝合。使用内窥镜针架用6-0prolene进行缝合，该针架将大的隔膜缺损转化为较小的蛛网膜租金，并且很容易被脂肪移植物堵塞。结果这些患者均无术后脑脊液漏。结论虽然在技术上很困难，直接修复膈膜是可能的。这增强了颅底重建，并有效减少了术后CSF泄漏的机会。
