未经批准:尽管鼻内颅底神经外科手术取得了进展,脑脊液(CSF)鼻漏仍然很常见且很重要。CRANIAL研究试图确定1)使用的颅底修复方法的范围,和2)经鼻蝶入路(TSA)和扩大经鼻入路(EEA)治疗颅底肿瘤的术后CSF鼻漏的相应发生率。
UNASSIGNED:一项前瞻性观察性队列研究,纳入了英国和爱尔兰30个进行鼻内颅底神经外科手术的中心(占成人单位的91%)。患者随访6个月,随访6个月。数据收集和分析以我们公布的方案和试点研究为指导。描述性统计,使用单变量和多变量逻辑回归模型进行分析。
未经批准:共纳入866例患者——726例TSA(84%)和140例EEA(16%)。各中心的修复方案存在显著的异质性。在运输安全管理局案件中,鼻腔填塞(519/726,72%),组织胶(474/726,65%)和止血剂(439/726,61%)是最常见的颅底修复技术。相对而言,带蒂皮瓣(90/140,64%),脑脊液分流(38/140,27%),支柱(17/140,12%)和垫片密封(11/140,9%)在EEA病例中更常用。在TSA的3.9%(28/726)和EEA的7.1%(10/140)的病例中,发生了CSF鼻漏(生化证实或需要再次手术)。当没有报告术中CSF泄漏时,发生了大量的CSF鼻漏患者(15/38,39%)。在多变量分析中,在TSA中使用组织胶可能会带来边际收益(OR:0.2,CI:0.1-0.7,p<0.01),但没有其他技术达到意义。有证据表明,某些特征使脑脊液鼻漏的可能性更大-例如先前的鼻内手术和术中脑脊液漏的存在。
UNASSIGNED:在各个中心都有广泛的颅底修复技术。总的来说,英国和爱尔兰的CSF鼻漏发生率低于文献中的一般报道。大部分术后漏液发生在术中隐匿性脑脊液漏液的情况下,和决策的普遍鞍座维修应考虑风险和成本效益的修复策略。未来的工作可能包括更长期的,更大量的研究,例如注册;和高质量的介入研究。
UNASSIGNED: Despite progress in endonasal skull-base neurosurgery, cerebrospinal fluid (CSF) rhinorrhoea remains common and significant. The CRANIAL
study sought to determine 1) the scope of skull-base repair methods used, and 2) corresponding rates of postoperative CSF rhinorrhoea in the endonasal transsphenoidal approach (TSA) and the expanded endonasal approach (EEA) for skull-base tumors.
UNASSIGNED: A prospective observational cohort
study of 30 centres performing endonasal skull-base neurosurgery in the UK and Ireland (representing 91% of adult units). Patients were identified for 6 months and followed up for 6 months. Data collection and analysis was guided by our published protocol and pilot studies. Descriptive statistics, univariate and multivariable logistic regression models were used for analysis.
UNASSIGNED: A total of 866 patients were included - 726 TSA (84%) and 140 EEA (16%). There was significant heterogeneity in repair protocols across centres. In TSA cases, nasal packing (519/726, 72%), tissue glues (474/726, 65%) and hemostatic agents (439/726, 61%) were the most common skull base repair techniques. Comparatively, pedicled flaps (90/140, 64%), CSF diversion (38/140, 27%), buttresses (17/140, 12%) and gasket sealing (11/140, 9%) were more commonly used in EEA cases. CSF rhinorrhoea (biochemically confirmed or requiring re-operation) occurred in 3.9% of TSA (28/726) and 7.1% of EEA (10/140) cases. A significant number of patients with CSF rhinorrhoea (15/38, 39%) occurred when no intraoperative CSF leak was reported. On multivariate analysis, there may be marginal benefits with using tissue glues in TSA (OR: 0.2, CI: 0.1-0.7, p<0.01), but no other technique reached significance. There was evidence that certain characteristics make CSF rhinorrhoea more likely - such as previous endonasal surgery and the presence of intraoperative CSF leak.
UNASSIGNED: There is a wide range of skull base repair techniques used across centres. Overall, CSF rhinorrhoea rates across the UK and Ireland are lower than generally reported in the literature. A large proportion of postoperative leaks occurred in the context of occult intraoperative CSF leaks, and decisions for universal sellar repairs should consider the risks and cost-effectiveness of repair strategies. Future work could include longer-term, higher-volume studies, such as a registry; and high-quality interventional studies.