Meier Joshua C, Bleier Benjamin S
Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles St., Boston, MA 02114, USA.
Adv Otorhinolaryngol. 2013;74:174-83. doi: 10.1159/000342294. Epub 2012 Dec 18.
The field of endoscopic skull base surgery has evolved considerably in recent years fueled largely by advances in both imaging and instrumentation. While the indications for these approaches continue to be extended, the ability to reconstruct the resultant defects has emerged as a rate-limiting obstacle. Postoperative failures with current multilayer grafting techniques remain significant and may increase as the indications for endoscopic resections continue to expand. Laser tissue welding represents a novel method of wound repair in which laser energy is applied to a chromophore doped biologic solder at the wound edge to create a laser weld (fig. 1). These repairs are capable of withstanding forces far exceeding those exerted by intracranial pressure with negligible collateral thermal tissue injury. Recent clinical trials have demonstrated the safety and feasibility of endoscopic laser welding while exposing the limitations of first generation hyaluronic acid based solders. Novel supersaturated gel based solders are currently being tested in clinical trials and appear to possess significantly improved viscoelastic properties. While laser tissue welding remains an experimental technique, continued success with these novel solder formulations may catalyze the widespread adoption of this technique for skull base repair in the near future.
近年来，内镜颅底手术领域发展迅速，这主要得益于成像技术和器械的进步。尽管这些手术方法的适应症不断扩大，但修复由此产生的缺损的能力已成为一个限制因素。目前多层移植技术的术后失败率仍然很高，并且随着内镜切除术适应症的不断扩大，失败率可能会增加。激光组织焊接是一种新型的伤口修复方法，在伤口边缘将激光能量应用于掺杂发色团的生物焊料上，以形成激光焊缝（图1）。这些修复能够承受远远超过颅内压所施加的力，同时附带的热组织损伤可忽略不计。最近的临床试验证明了内镜激光焊接的安全性和可行性，同时也揭示了第一代基于透明质酸的焊料的局限性。新型的基于过饱和凝胶的焊料目前正在临床试验中进行测试，并且似乎具有显著改善的粘弹性特性。虽然激光组织焊接仍然是一种实验性技术，但这些新型焊料配方的持续成功可能会促使该技术在不久的将来被广泛应用于颅底修复。
