Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Kangnam-gu, Seoul, Korea.
Acta Neurochir (Wien). 2012 Apr;154(4):659-64; discussion 664. doi: 10.1007/s00701-012-1293-5. Epub 2012 Feb 21.
Skull base reconstruction after endoscopic endonasal resection of a variety of skull base lesions remains challenging because of some lethal complications such as cerebrospinal fluid (CSF) leaks. We investigated the outcomes of hydroxyapatite (HA) cement patch as on-lay graft for skull base defects following endoscopic endonasal approach (EEA).
We analyzed 53 consecutive patients who underwent sellar reconstruction using HA cement following EEA at our institution between July 2009 and March 2011. Patients were composed of 23 men and 30 women with a mean age of 47 years, ranging from 10 to 72 years. Among these patients, 29 patients (54.7%) experienced intraoperative CSF leaks with high-output, 10 patients (18.9%) underwent CSF leaks with low output, and 14 patients (26.4%) experienced no intraoperative CSF leak. Mean follow-up period for clinical outcomes was 8.6 months (range, 3-22 months).
We performed injectable HA patch as on-lay graft over fascia lata for the skull base defects. Routine lumbar CSF drainage was not performed postoperatively in any patients since the introduction of HA. During the follow-up period, three of 53 patients (5.6%) demonstrated meningitis associated with postoperative CSF leaks and underwent re-do reconstruction surgery. There was no allergic symptoms associated with HA cement. At an outpatient clinic, the defects were found to be covered with surrounding nasal mucosa at an average of 14 weeks (range, 3-28 weeks).
The use of HA cement as an on-lay patch for the reconstruction of sellar defect demonstrated a low incidence of CSF leaks with minimal complications. HA cement may be an alternative option for repair of CSF leaks following EEA.
内镜经鼻入路切除各种颅底病变后进行颅底重建仍然具有挑战性，因为存在一些致命的并发症，如脑脊液（CSF）漏。我们研究了羟基磷灰石（HA）水泥补丁作为内镜经鼻入路（EEA）后颅底缺损的覆盖移植物的结果。
我们分析了 2009 年 7 月至 2011 年 3 月期间在我们机构接受 EEA 后使用 HA 水泥进行鞍重建的 53 例连续患者。患者由 23 名男性和 30 名女性组成，平均年龄为 47 岁，年龄范围为 10 至 72 岁。这些患者中，29 例（54.7%）术中出现高流量 CSF 漏，10 例（18.9%）出现低流量 CSF 漏，14 例（26.4%）无术中 CSF 漏。临床结果的平均随访时间为 8.6 个月（范围为 3-22 个月）。
我们对筋膜进行了可注射的 HA 补丁作为颅底缺损的覆盖移植物。自 HA 引入以来，术后没有对任何患者进行常规腰椎 CSF 引流。在随访期间，53 例患者中有 3 例（5.6%）出现与术后 CSF 漏相关的脑膜炎，并进行了再次重建手术。HA 水泥无过敏症状。在门诊，平均 14 周（范围为 3-28 周）后发现缺损被周围的鼻粘膜覆盖。
HA 水泥作为鞍区缺损重建的覆盖移植物使用，CSF 漏发生率低，并发症少。HA 水泥可能是 EEA 后修复 CSF 漏的一种替代选择。
