Zieliński Grzegorz, Podgórski Jan Krzysztof, Koziarski Andrzej, Potakiewicz Ziemowit
Klinika Neurochirurgii, Wojskowy Instytut Medyczny, 00-909 Warszawa.
Neurol Neurochir Pol. 2006 Jul-Aug;40(4):302-11; disussion 312.
Transsphenoidal microsurgery (TSS) is the method of choice for resection of most pituitary tumors. Postoperative cerebrospinal fluid rhinorrhea is one of the most frequent complications of TSS. Its incidence ranges from 1.3 to 9.6%. Failure to close a cerebrospinal fistula can result in life-threatening complications e. g. meningitis or tension pneumocephalus. Therefore sellar closure has to be done properly certainly and has to be watertight. The aim of the study was to evaluate the results of reconstruction of the skull base after TSS with autologous material (fascia lata and fat or muscle).
Our operative experience of reconstruction of the sellar floor during transsphenoidal surgery is described. We report the well known method of the sellar closure using autologous tissue (fascia lata and fat or muscle). We did not use other materials e.g., fibrin glue, titanium mesh etc. This technique has been performed in 316 patients.
The postoperative cerebrospinal fluid leakage occurred in 7 patients. Four of them underwent early reoperation. Three others were treated successfully with lumbar drainage. In another patient, a cerebrospinal fistula occurred during chronic pharmacotherapy of the giant PRL-secreting adenoma. Transsphenoidal reconstruction of the skull base according to the described method was performed in that case. Lethal meningitis occurred in one patient in our group.
In our opinion the described method of reconstruction of the sellar floor is easy, safe and very effective.
经蝶窦显微手术（TSS）是大多数垂体肿瘤切除的首选方法。术后脑脊液鼻漏是TSS最常见的并发症之一。其发生率在1.3%至9.6%之间。脑脊液瘘未能闭合可导致危及生命的并发症，如脑膜炎或张力性气颅。因此，鞍底封闭必须妥善完成且确保水密。本研究的目的是评估使用自体材料（阔筋膜、脂肪或肌肉）进行TSS后颅底重建的结果。
描述了我们在经蝶窦手术中重建鞍底的手术经验。我们报告了使用自体组织（阔筋膜、脂肪或肌肉）进行鞍底封闭的知名方法。我们未使用其他材料，如纤维蛋白胶、钛网等。该技术已应用于316例患者。
7例患者术后出现脑脊液漏。其中4例接受了早期再次手术。另外3例通过腰椎引流成功治疗。在另一例患者中，巨大泌乳素分泌性腺瘤的慢性药物治疗期间发生了脑脊液瘘。在此病例中，按照所述方法进行了经蝶窦颅底重建。我们组有1例患者发生致命性脑膜炎。
我们认为，所述鞍底重建方法简便、安全且非常有效。
