Department of Neurosurgery, Hackensack University Medical Center, Hackensack, New Jersey, USA.
Neurosurgery. 2011 Mar;68(1 Suppl Operative):144-50; discussion 150-1. doi: 10.1227/NEU.0b013e318207b3fc.
Nonvascularized autologous grafts used for sellar reconstruction in transseptal transsphenoidal surgery are commonly applied in the setting of intraoperative cerebrospinal fluid (CSF) leak and have been shown to be effective in preventing postoperative complications.
To assess the clinical implications of intraoperative CSF leak, to evaluate the efficacy of repair techniques using autologous nonvascularized materials, and to analyze the nature and timing of failures. These data may serve as a basis for assessing the utility of innovations in techniques and implant technologies.
A review was conducted of 257 consecutive patients who underwent transsphenoidal surgery that was complicated by intraoperative CSF leak from 1995 to 2001. Sellar reconstruction was performed with autologous materials except in reoperations in which septal materials were not available; lumbar drain catheters were used selectively.
Six of the 257 patients (2.3%) developed postoperative CSF rhinorrhea occurring an average of 6.6 days after surgery. All 6 underwent reoperation, with 5 of 6 managed with operative lumbar drainage. Bacterial meningitis developed in 3 of 257 (1.2%). Worsening in visual function occurred in 8 of 257 (3.1%), with 1 of 257 (0.3%) suffering from permanent worsening of visual function. Additional surgery was performed in 2 of these patients, resulting in successful reversal of visual loss. Ten of 257 patients (3.9%) developed a subcutaneous hematoma at the fat graft harvest site, with 1 patient requiring surgical re-exploration.
Watertight closure of the sella with autologous materials is effective in preventing postoperative rhinorrhea. Complications specific to the technique include graft site hematoma (4%) and rare instances of visual loss caused by optic nerve compression.
在经鼻中隔经蝶窦手术中，用于鞍底重建的非血管化自体移植物常用于术中脑脊液 (CSF) 漏的情况，已被证明可有效预防术后并发症。
评估术中 CSF 漏的临床意义，评估使用自体非血管化材料进行修复的效果，并分析失败的性质和时间。这些数据可作为评估技术和植入物技术创新实用性的基础。
回顾了 1995 年至 2001 年期间 257 例经蝶窦手术中发生术中 CSF 漏的连续患者。除再次手术中没有鼻中隔材料可用的情况外，所有患者均使用自体材料进行鞍底重建，选择性使用腰椎引流管。
257 例患者中有 6 例（2.3%）发生术后 CSF 鼻漏，平均发生在术后 6.6 天。所有 6 例患者均接受再次手术，其中 5 例采用手术性腰椎引流。257 例患者中有 3 例（1.2%）发生细菌性脑膜炎。257 例中有 8 例（3.1%）视力功能恶化，其中 1 例（0.3%）视力永久性恶化。在这 2 例患者中进行了额外的手术，导致视力丧失成功逆转。257 例中有 10 例（3.9%）在脂肪移植物采集部位出现皮下血肿，其中 1 例需要再次手术探查。
使用自体材料对鞍底进行严密缝合可有效预防术后鼻漏。该技术特有的并发症包括移植物部位血肿（4%）和罕见的视神经压迫导致视力丧失。
