Cohen-Gadol A A, Bellew M P, Akard W, Payner T D
Clarian Neuroscience Institute, Goodman-Campbell Brain & Spine, and Indiana University Department of Neurosurgery, 1801 North Senate Blvd. # 610, Indianapolis, IN 46202, USA.
Minim Invasive Neurosurg. 2010 Aug;53(4):207-9. doi: 10.1055/s-0030-1262813. Epub 2010 Dec 3.
The adequate repair of intraoperative CSF leaks during transsphenoidal surgery remains a challenge. The authors describe the application of N-butyl 2-cyanoacrylate (cyanoacrylate) tissue glue for repair of CSF fistulas during transsphenoidal surgery.
The authors retrospectively reviewed the records of 221 consecutive patients who underwent transsphenoidal surgery during 1998-2007. Among these patients, 52 (24%) experienced detectable intraoperative CSF leakage. The CSF fistulas were graded on a scale of 1-3, according to the amount of CSF loss and extent of diaphragmatic disruption. 39 patients who had an average leak scale of 1.28 received cyanoacrylate glue to seal the floor. The remaining 13 patients who were not part of this report received other dura sealant substitutes, including Tisseel and Dura Seal, or fat/cartilage grafts without any additional glue material.
4 of 221 patients (2%) who underwent surgery had postoperative CSF fistula. Of the 39 patients who underwent repair of their fistula using fat graft, cartilage/bone buttress and cyanoacrylate reconstruction, 2 (5.13%) developed postoperative CSF fistulas without any other side effects. The average intraoperative leak grade in these 2 patients was 2.00.
The authors used cyanoacrylate glue for intraoperative repair of higher grade CSF fistulas. As an adjunct to careful sellar reconstruction, cyanoacrylate glue appears to be effective and safe in preventing postoperative CSF leakage after transsphenoidal surgery.
经蝶窦手术中脑脊液漏的充分修复仍是一项挑战。作者描述了应用氰基丙烯酸正丁酯（氰基丙烯酸酯）组织胶修复经蝶窦手术中的脑脊液瘘。
作者回顾性分析了1998年至2007年间连续221例行经蝶窦手术患者的病历。在这些患者中，52例（24%）术中出现可检测到的脑脊液漏。根据脑脊液丢失量和鞍膈破坏程度，将脑脊液瘘分为1 - 3级。39例平均漏级为1.28的患者接受了氰基丙烯酸酯胶封闭鞍底。其余13例未纳入本报告的患者接受了其他硬脑膜密封替代物，包括纤维蛋白胶和硬脑膜封闭剂，或脂肪/软骨移植，未使用任何额外的胶水材料。
221例手术患者中有4例（2%）术后出现脑脊液瘘。在39例使用脂肪移植、软骨/骨支撑和氰基丙烯酸酯重建修复瘘管的患者中，2例（5.13%）出现术后脑脊液瘘，无任何其他副作用。这2例患者术中平均漏级为2.00。
作者使用氰基丙烯酸酯胶术中修复较高级别的脑脊液瘘。作为仔细的鞍区重建的辅助手段，氰基丙烯酸酯胶在预防经蝶窦手术后脑脊液漏方面似乎是有效且安全的。
