Falcioni M, Mulder J J, Taibah A, De Donato G, Sanna M
Gruppo Otologico, Piacenza, Italy.
Am J Otol. 1999 Sep;20(5):660-6.
The objective of this study was to validate measures taken to reduce the number of cerebrospinal fluid (CSF) leaks after removal of vestibular schwannomas to 0.
This study was a retrospective case review.
The study was conducted at an otology/neurotology tertiary referral center (Gruppo Otologico, Piacenza, Italy).
Three hundred thirty-one vestibular schwannoma patients were studied.
The enlarged translabyrinthine approach (TLA) was used in all cases, with a number of modifications in the last 200 patients. It was extended in 22 patients with blind sac closure of the external meatus, removal of the posterior bony canal wall, and obliteration of the Eustachian tube and middle ear.
Whether patients had a leak through the wound, the nose (rhinoliquorrhea), or the ear (otoliquorrhea) was assessed.
In an early group, the percentage of CSF leaks was 6.9%. On the basis of the evaluated causes, as time went by, technical modifications evolved. They consisted of 1) the total conservation of the fascioperiosteal flap, 2) obliteration of all petrosal cells possibly communicating with the middle ear, 3) removing the incus in a correct way, 4) closing the attic with periosteum, 5) obliterating the surgical cavity, leaving strips of abdominal fat with their medial ends inside the cerebellopontine angle, 6) suturing the musculo-periosteal layer in a correct way, and 7) fixing the skin flap to the underlying surface. The application of these modifications resulted in a total absence of CSF leaks in 200 consecutive patients thereafter. Also, no cases of meningitis were encountered.
To our knowledge, this is the first series of 200 consecutive vestibular schwannoma patients operated by means of the enlarged TLA without a single CSF leak. When the appropriate measures are taken, the number of CSF leaks after removing tumors through the enlarged TLA must and can be reduced to 0.
本研究的目的是验证为将前庭神经鞘瘤切除术后脑脊液（CSF）漏的数量降至零而采取的措施。
本研究为回顾性病例分析。
该研究在一家耳科/神经耳科三级转诊中心（意大利皮亚琴察的Gruppo Otologico）进行。
对331例前庭神经鞘瘤患者进行了研究。
所有病例均采用扩大经迷路入路（TLA），并对后200例患者进行了一些改良。对22例患者扩大了该入路，包括外耳道盲袋封闭、后骨管后壁切除、咽鼓管和中耳闭塞。
评估患者是否存在伤口漏、鼻漏（脑脊液鼻漏）或耳漏（脑脊液耳漏）。
在早期组中，脑脊液漏的发生率为6.9%。根据评估的原因，随着时间的推移，技术改良不断发展。改良措施包括：1）完全保留筋膜骨膜瓣；2）闭塞所有可能与中耳相通的岩骨气房；3）正确切除砧骨；4）用骨膜封闭上鼓室；5）闭塞手术腔，在桥小脑角内留置腹部脂肪条，其内侧端置于腔内；6）正确缝合肌肉骨膜层；7）将皮瓣固定于下方表面。采用这些改良措施后，其后连续200例患者均未出现脑脊液漏。此外，未发生脑膜炎病例。
据我们所知，这是首例连续200例采用扩大TLA手术的前庭神经鞘瘤患者，无一例脑脊液漏。采取适当措施后，通过扩大TLA切除肿瘤后的脑脊液漏数量必然且能够降至零。
