Sekhar L N, Sarma S, Morita A
Mid-Atlantic Brain and Spine Institutes, Annandale, Virginia 22003, USA.
Neurosurgery. 2001 Sep;49(3):749-51; discussion 751-2. doi: 10.1097/00006123-200109000-00043.
After the resection of cranial base tumors, there may not be enough free dural margin left for reconstruction after involved bone and dura have been removed. In such a situation, dural reconstruction becomes a problem. We propose a new technique of dural closure in such cases.
A fascial graft is prepared from either fascia lata, abdominal fascia, pericranium, or temporal fascia and is trimmed to a size slightly larger than that of the dural defect. The fascial graft is placed over the dural defect and affixed to the underlying bone with a piece of titanium mesh, titanium screws, or both. The graft is then reinforced with fibrin glue.
This method of dural reconstruction has been used in five patients with basal meningiomas. Three were in the petromastoid area, and two were in the planum-ethmoid area. None of these patients experienced postoperative cerebrospinal fluid leak, and none experienced any complications related to the reconstruction.
This technique of dural reconstruction can be used in selected cases of basal tumors without enough free dural margin to sew into a fascial graft.
颅底肿瘤切除术后，去除受累骨质和硬脑膜后，可能没有足够的游离硬脑膜边缘用于重建。在这种情况下，硬脑膜重建成为一个问题。我们提出一种在此类病例中进行硬脑膜闭合的新技术。
从阔筋膜、腹筋膜、颅骨膜或颞筋膜制备筋膜移植物，并将其修剪至略大于硬脑膜缺损的尺寸。将筋膜移植物置于硬脑膜缺损上方，并用一块钛网、钛螺钉或两者将其固定于下方骨质。然后用纤维蛋白胶加固移植物。
这种硬脑膜重建方法已用于5例基底脑膜瘤患者。3例位于岩乳突区，2例位于筛板区。这些患者均未发生术后脑脊液漏，也未出现与重建相关的任何并发症。
这种硬脑膜重建技术可用于硬脑膜游离边缘不足无法缝合到筋膜移植物中的特定基底肿瘤病例。
