Dusick Joshua R, Mattozo Carlos A, Esposito Felice, Kelly Daniel F
Division of Neurosurgery, University of California at Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA.
Surg Neurol. 2006 Oct;66(4):371-6; discussion 376. doi: 10.1016/j.surneu.2006.06.043.
The efficacy of BioGlue (CryoLife, Inc, Atlanta, Ga) surgical adhesive in transsphenoidal surgery was assessed as an adjunct in the prevention of postoperative CSF leaks.
All patients in whom BioGlue was used for an intraoperative skull base reconstruction were retrospectively identified. Intraoperative CSF leaks were graded according to size (grade 1, small weeping leak without obvious diaphragmatic defect; grade 2, moderate leak with a definite diaphragmatic defect; grade 3, large diaphragmatic and/or dural defect). CSF leak repair was tailored to CSF leak grade. BioGlue was applied as a reinforcement over collagen sponge as the last layer of the repair.
Over 28 months, a total of 282 patients underwent endonasal surgery. Of these patients, 124 (79 women; age range, 8-84 years), in 128 procedures, had an intraoperative CSF leak repair reinforced with BioGlue. Pathology included 80 pituitary adenomas, 11 craniopharyngiomas, 7 Rathke's cleft cysts, 6 chordomas, 5 meningiomas, 4 spontaneous CSF leaks, 3 arachnoid cysts, and 8 other parasellar pathologies. There were 62 (48.4%) grade 1, 41 (32.0%) grade 2, and 25 (19.5%) grade 3 leak repairs. The overall repair failure rate was 1.6% (2 cases), with the failures occurring in patients with grade 3 leaks, including 1 who developed meningitis; there was no failure of grades 1 and 2 leaks. The 2 failures were attributed largely to technical aspects of the repair rather than to failure of BioGlue per se.
BioGlue appears to be an effective adjunct in preventing postoperative CSF leaks after transsphenoidal surgery. However, careful attention to technical details of the repair is still required to prevent failures, especially when closing large dural and diaphragmatic defects.
评估了BioGlue（CryoLife公司，佐治亚州亚特兰大）手术粘合剂在经蝶窦手术中作为预防术后脑脊液漏辅助手段的疗效。
对所有术中使用BioGlue进行颅底重建的患者进行回顾性识别。术中脑脊液漏根据大小分级（1级，少量渗漏且无明显膈缺损；2级，中度渗漏且有明确膈缺损；3级，大的膈和/或硬脑膜缺损）。脑脊液漏修补根据脑脊液漏分级进行调整。BioGlue作为修复的最后一层，涂覆在胶原海绵上作为加固。
在28个月期间，共有282例患者接受了鼻内手术。其中，124例（79名女性；年龄范围8 - 84岁）在128次手术中进行了术中脑脊液漏修补并使用BioGlue加固。病理类型包括80例垂体腺瘤、11例颅咽管瘤、7例拉克氏囊肿、6例脊索瘤、5例脑膜瘤、4例自发性脑脊液漏、3例蛛网膜囊肿和8例其他鞍旁病变。有62例（48.4%）为1级漏修补，41例（32.0%）为2级漏修补，25例（19.5%）为3级漏修补。总体修补失败率为1.6%（2例），失败发生在3级漏患者中，其中1例发生脑膜炎；1级和2级漏无失败病例。这2例失败主要归因于修补的技术方面，而非BioGlue本身失效。
BioGlue似乎是经蝶窦手术后预防术后脑脊液漏的有效辅助手段。然而，仍需仔细关注修补的技术细节以防止失败，尤其是在闭合大的硬脑膜和膈缺损时。
