背景:内窥镜颅底手术后脑脊液漏仍然是一个严重的并发症。几位研究人员建议使用Hydroset颅骨成形术来减少泄漏率。我们调查了我们使用Hydroset的早期经验,并将鼻腔并发症和CSF泄漏率与病例对照的历史对照进行了比较。
方法:我们查询了接受首次内镜检查的患者的前瞻性数据库,2015年至2023年鼻内切除鞍上脑膜瘤和颅咽管瘤。我们比较了用垫圈密封封闭的案例,Hydroset,和鼻中隔皮瓣,只有密封垫和鼻中隔皮瓣封闭。人口统计,比较了技术考虑因素和术后结局(SNOT-22).
结果:70例患者符合纳入标准,Hydroset组20例患者(脑膜瘤n=12;颅咽管瘤n=8)和50例对照患者(脑膜瘤n=25;颅咽管瘤n=25)。脑脊液分流术用于较少的Hydroset患者(75%,15/20)与对照组(94%,47/50;p=0.02)。与对照组相比,Hydroset的CSF泄漏频率较低(5%对12%,p=0.38)。一名Hydroset患者需要延迟鼻清创。SNOT-22反应显示两组之间在鼻窦不适方面没有显着差异(Hydroset平均SNOT-22得分22.45,对照平均SNOT-22得分25.90;p=0.58)。
结论:我们证明羟基磷灰石重建可改善脑脊液渗漏控制,只要骨水泥完全被血管化组织覆盖,就没有明显的相关发病率。
BACKGROUND: Cerebrospinal fluid leak after endoscopic skull base surgery remains a significant complication. Several investigators have suggested Hydroset cranioplasty to reduce leak rates. We investigated our early experience with Hydroset and compared the rate of nasal complications and CSF leak rates with
case-controlled historic controls.
METHODS: We queried a prospective database of patients undergoing first time endoscopic, endonasal resection of suprasellar meningiomas and craniopharyngiomas from 2015 to 2023. We compared cases closed with a gasket seal, Hydroset, and a nasoseptal flap with those closed with only a gasket seal and nasoseptal flap. Demographics, technical considerations and postoperative outcomes (SNOT-22) were compared.
RESULTS: Seventy patients met inclusion criteria, twenty patients in the Hydroset group (meningioma n = 12; craniopharyngioma n = 8) and 50 control patients (meningioma n = 25; craniopharyngioma n = 25). CSF diversion was used in fewer Hydroset patients (75%, 15/20) compared with control group (94%, 47/50; p = 0.02). CSF leak was less frequent in the Hydroset than the control group (5% versus 12%, p = 0.38). One Hydroset patient required delayed nasal debridement. SNOT-22 responses demonstrated no significant difference in sinonasal complaints between groups (Hydroset average SNOT-22 score 22.45, control average SNOT-22 score 25.90; p = 0.58).
CONCLUSIONS: We demonstrate that hydroxyapatite reconstruction leads to improved CSF leak control above that provided by the gasket-seal and nasoseptal flap, without significant associated morbidity as long as the cement is fully covered with vascularized tissue.