Department of Neurological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, Naples, Italy.
Acta Neurochir (Wien). 2010 May;152(5):897-904. doi: 10.1007/s00701-009-0580-2. Epub 2010 Jan 5.
The objective of this study is to report our experience and illustrate our technique in the use of fibrin glue in the treatment of post-operatory cerebrospinal fluid (CSF) leaks and collections following different neurosurgical procedures.
In a 3-year period, 40 subjects underwent endoscopic endonasal approach for different sellar and skull base lesions (three tuberculum sellae meningiomas, six craniopharyngiomas, three Rathke's cleft cysts and 28 pituitary macroadenomas), in which an intraoperative CSF leakage was evident. In such subjects, the fibrin glue was used as a first step of the final phase of the procedure-i.e. the reconstruction of the skull base defect-followed by the other materials employed. Furthermore, ten other patients, who had undergone transsphenoidal (four cases), spinal (two cases), posterior fossa (three cases) and transcortical intraventricular tumour removal (one case) neurosurgical procedures and developed CSF leaks or collections, were conservatively treated by single or repeated in situ injections of "modified" fibrin glue under local anaesthesia according to different described techniques. In total, 50 patients constitute the clinical material of the present study.
In the cases where the fibrin glue was used during the reconstruction phase of the procedure (40 cases), the glue was injected inside the tumour cavity to fill the dead space left by the removal of the lesion. In case of post-operative CSF leak or CSF fluid collection (ten cases), after discarding 50-80% of the thrombin solution to obtain prevalence of the product's adhesive properties, fibrin glue was injected directly in the path of the CSF leak or into the collection cavity after aspiration of the collection's content. This was performed with the provided application system or through lumbar or Tuohy needles. Applications were repeated every 48 h until the disappearance of the leak. In all the treated cases, the disappearance of CSF leaks or collections was obtained with a number of applications ranging from one to five. Successful results are stable with a follow-up ranging from 6 months to 3 years.
In our experience, the injection of fibrin glue has proved to be effective in filling or sealing post-operative "dead spaces" and treating minor or initial CSF leaks resulting from procedures of transsphenoidal, cranial and spinal surgery, adding another possibility in the management of many of these dreadful complications.
本研究旨在报告我们在不同神经外科手术中使用纤维蛋白胶治疗术后脑脊液（CSF）漏和积聚的经验，并举例说明我们的技术。
在 3 年期间，40 名接受经鼻内镜颅底入路治疗鞍区和颅底不同病变的患者（三例鞍结节脑膜瘤、六例颅咽管瘤、三例 Rathke 裂囊肿和 28 例垂体大腺瘤）术中出现明显的 CSF 漏。在这些患者中，纤维蛋白胶首先用于手术最后阶段（即颅底缺损重建），然后使用其他材料。此外，10 例接受经蝶窦（4 例）、脊髓（2 例）、后颅窝（3 例）和经皮质脑室肿瘤切除术（1 例）神经外科手术并出现 CSF 漏或积聚的患者，根据不同描述的技术，在局部麻醉下单次或重复原位注射“改良”纤维蛋白胶进行保守治疗。总共 50 例患者构成本研究的临床资料。
在术中重建阶段使用纤维蛋白胶的病例（40 例）中，将胶注入肿瘤腔内以填充病变切除后留下的死腔。对于术后 CSF 漏或 CSF 积液（10 例），在丢弃 50-80%的凝血酶溶液以获得产品粘合性能优势后，直接将纤维蛋白胶注入 CSF 漏或抽吸积液内容物后的积液腔内注射。这是通过提供的应用系统或通过腰椎或 Tuohy 针进行的。应用每 48 小时重复一次，直到漏液消失。在所有治疗的病例中，通过 1 至 5 次应用获得了 CSF 漏或积聚的消失。成功的结果是稳定的，随访时间从 6 个月到 3 年不等。
根据我们的经验，纤维蛋白胶注射已被证明可有效填充或密封术后“死腔”，并治疗经蝶窦、颅腔和脊髓手术引起的轻微或初始 CSF 漏，为许多这些可怕并发症的治疗增加了另一种可能性。
