目的:在鼻内镜手术(EES)中已采用各种非血管化或血管化技术来修复肿瘤切除术后的术中脑脊液(CSF)渗漏。血管化鼻中隔皮瓣(VNSF),游离鼻中隔移植物(FNSG),游离鼻甲移植物(FTG),经常使用阔筋膜和捣碎肌(FLMM)。需要澄清在不同区域缺陷中应用这些移植物的结果。
方法:回顾性分析2012年1月至2021年1月接受EES手术的162例颅底肿瘤患者的数据。这些区域包括前颅底(ASB),塞拉地区,clivus和颞下窝(ITF)。维修故障率(RFR),评估脑膜炎发生率和相关危险因素。
结果:总计,162例患者在颅底的四个部位进行了172例重建。术后有7例(4.3%)脑脊液漏,需要第二次修理。ASB的RFR,塞拉地区,Clivus,ITF为2.6%,2.2%,16.7%,0%,分别。clivus缺损是修复失败的独立危险因素(P<0.01)。术后脑膜炎发生率为5.6%。修复失败是脑膜炎的独立危险因素(P<0.01)。
结论:VNSF,FNSG,FTG,FLMM是可靠的自体材料,可用于修复EES期间不同区域的硬脑膜缺损。Clivus重建仍然是一个巨大的挑战,具有较高的RFR和脑膜炎发生率。修复失败与术后脑膜炎显著相关。
OBJECTIVE: Various nonvascularized or vascularized techniques have been adopted in endoscopic endonasal surgery (EES) for repairing intraoperative cerebrospinal fluid (CSF) leaks after tumor resection. Vascularized nasoseptal flaps, free nasoseptal grafts, free turbinate grafts, and fascia lata and mashed muscle are frequently used. Outcomes of those grafts applied in the defects of different regions need to be clarified.
METHODS: The data from a series of 162 patients with skull base tumor who underwent EES that had intraoperative CSF leak between Jan 2012 and Jan 2021 were retrospectively analyzed. The regions included anterior skull base, sellar region, clivus and infratemporal fossa. Repair failure rate (RFR), meningitis rate, and associated risk factors were assessed.
RESULTS: In total, 172 reconstructions were performed in 162 patients for the 4 sites of the skull base. There were 7 cases (4.3%) that had postoperative CSF leaks, which required second repair. The RFR for anterior skull base, sellar region, clivus, and infratemporal fossawas 2.6%, 2.2%, 16.7%, and 0%, respectively. The clivus defect was an independent risk factor for repair failure (P < 0.01). The postoperative meningitis rate was 5.6%. Repair failure was an independent risk factor for meningitis (P < 0.01).
CONCLUSIONS: Vascularized nasoseptal flap, free nasoseptal graft, free turbinate graft, and fascia lata and mashed muscle are reliable autologous materials for repairing the dural defects in different regions during EES. Clivus reconstruction remains a great challenge, which had a higher RFR and meningitis rate. Repair failure is significantly associated with postoperative meningitis.