Leng Lewis Z, Brown Seth, Anand Vijay K, Schwartz Theodore H
Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
Neurosurgery. 2008 May;62(5 Suppl 2):ONSE342-3; discussion ONSE343. doi: 10.1227/01.neu.0000326017.84315.1f.
Transnasal endoscopic cranial base surgery is a novel minimal-access method for reaching the midline cranial base. Postoperative cerebrospinal fluid leak remains a persistent challenge. A new method for watertight closure of the anterior cranial base is presented.
To achieve watertight closure of the anterior cranial base, autologous fascia lata was used to create a "gasket seal" around a bone buttress, followed by application of a tissue sealant such as DuraSeal (Confluent Surgical, Inc., Waltham, MA). The gasket-seal closure was used to seal the anterior cranial base in a series of 10 patients with intradural surgery for suprasellar craniopharyngiomas (n = 5), planum meningiomas (n = 3), clival chordoma (n = 1), and recurrent iatrogenic cerebrospinal fluid leak (n = 1). Lumbar drains were placed intraoperatively in five patients and remained in place for 3 days postoperatively.
After a mean follow-up period of 12 months, there were no cerebrospinal fluid leaks.
The gasket-seal closure is an effective method for achieving watertight closure of the anterior cranial base after endoscopic intradural surgery.
经鼻内镜颅底手术是一种用于抵达颅底中线的新型微创方法。术后脑脊液漏仍然是一个持续存在的挑战。本文介绍一种用于前颅底水密性封闭的新方法。
为实现前颅底的水密性封闭，使用自体阔筋膜在骨支撑物周围创建一个“垫圈密封”，随后应用诸如DuraSeal（Confluent Surgical公司，马萨诸塞州沃尔瑟姆）之类的组织密封剂。在一系列10例接受鞍上颅咽管瘤（n = 5）、蝶骨平台脑膜瘤（n = 3）、斜坡脊索瘤（n = 1）及复发性医源性脑脊液漏（n = 1）硬膜内手术的患者中，采用垫圈密封封闭法来封闭前颅底。术中5例患者放置了腰大池引流管，术后保留3天。
平均随访12个月后，未出现脑脊液漏。
垫圈密封封闭法是在内镜硬膜内手术后实现前颅底水密性封闭的有效方法。
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