Gil Ziv, Shaham Amit, Vasilyev Tamar, Brosh Tamar, Forer Boaz, Katzir Abraham, Fliss Dan M
Skull Base Surgery Unit and the Department of Otolaryngology, Head and Neck Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv, Israel.
J Neurosurg. 2005 Jul;103(1):87-91. doi: 10.3171/jns.2005.103.1.0087.
The goal of this study was to use a modified version of the CO2 laser-soldering system to develop a simple and reliable technique for the repair of dural defects after excision of brain tumors.
The authors used a CO2 fiber optic laser system that they had developed for heating, monitoring, and controlling tissue temperature in situ and in real time, thereby reducing damage to the brain parenchyma. They adapted the system for dural closure by using free fascial grafts in a porcine model. Measures for estimation of reconstruction quality included visual assessment under magnification and direct measurements of adhesive strength and cerebrospinal fluid leak (CSF) pressure. Reliable soldering was achieved in 54 of 57 experiments, providing a 95% success rate. The average peak adhesive strength was 82 +/- 3 mN/cm2. The measured leak pressure of the fascia-dura mater bond was 66 +/- 5 mm Hg. Conventional suturing performed using Prolene stitches resulted in immediate CSF leakage from areas between the stitches and from the area of the needle hole itself.
Fascia-dura mater soldering using the CO2 laser is feasible and may support CSF pressure up to six times higher than normal intracranial pressure. Findings of this study may provide a basis for the development of new tools for dural reconstruction.
本研究的目的是使用二氧化碳激光焊接系统的改良版本，开发一种简单可靠的技术，用于修复脑肿瘤切除术后的硬脑膜缺损。
作者使用了他们开发的一种二氧化碳光纤激光系统，该系统可在原位实时加热、监测和控制组织温度，从而减少对脑实质的损伤。他们在猪模型中使用游离筋膜移植物对该系统进行了硬脑膜闭合的适应性改造。评估重建质量的措施包括放大倍数下的视觉评估以及对粘合强度和脑脊液漏（CSF）压力的直接测量。57次实验中有54次实现了可靠的焊接，成功率为95%。平均峰值粘合强度为82±3 mN/cm2。测量的筋膜 - 硬脑膜结合处的漏压为66±5 mmHg。使用普理灵缝线进行的传统缝合导致缝线之间区域以及针孔本身区域立即出现脑脊液漏。
使用二氧化碳激光进行筋膜 - 硬脑膜焊接是可行的，并且可以承受比正常颅内压高六倍的脑脊液压力。本研究结果可为开发新的硬脑膜重建工具提供依据。
