Department of Neurosurgery, Nippon Medical School, Tokyo, Japan.
Department of Neurosurgery, Nippon Medical School, Tokyo, Japan.
World Neurosurg. 2014 Feb;81(2):344-7. doi: 10.1016/j.wneu.2013.01.032. Epub 2013 Jan 11.
Cerebrospinal fluid leakage and meningitis caused by frontal sinus (FS) exposure are characteristic complications of bifrontal craniotomy used for treating skull base tumors and anterior communicating artery aneurysms. Prevention of these complications is of utmost importance. We describe in detail our procedure for sealing exposed FSs during bifrontal craniotomy and present the results and outcomes of the procedure.
A total of 51 consecutive patients who had undergone bifrontal craniotomy for tuberculum sellae meningiomas, craniopharyngiomas, anterior cerebral artery aneurysms, or other frontal skull base lesions at our institute were selected for the study. Our technique for sealing exposed FSs is described below. The mucosa was sterilized using surgical cotton dipped in iodine. After craniotomy, the exposed mucosa was sealed using 7-0 nylon sutures, whereas Gelfoam with fibrin glue was used to ensure watertight closure. The exposed portions of the FSs were covered by bone covers made of internal table bone and sealed. As a final layer, frontal periosteal flaps were sutured to the frontal base dura mater.
Postoperative cerebrospinal fluid leakage or meningitis did not occur in any of our patients.
Our results indicate the effectiveness of our technique in the prevention of FS-related postoperative complications.
额窦（FS）暴露引起的脑脊液漏和脑膜炎是用于治疗颅底肿瘤和前交通动脉动脉瘤的双额开颅术的特征性并发症。预防这些并发症至关重要。我们详细描述了在双额开颅术中封闭暴露的 FS 的程序，并介绍了该程序的结果和效果。
我们选择了 51 例连续接受双额开颅术治疗鞍结节脑膜瘤、颅咽管瘤、大脑前动脉动脉瘤或其他额颅底病变的患者进行研究。我们封闭暴露 FS 的技术如下。用蘸有碘的手术棉对黏膜进行消毒。开颅后，用 7-0 尼龙缝线封闭暴露的黏膜，而使用纤维蛋白胶的明胶海绵以确保密封。用内板骨制成的骨盖覆盖 FS 的暴露部分并进行密封。作为最后一层，将额部骨膜瓣缝合到额骨底部硬脑膜上。
我们的患者术后均未出现脑脊液漏或脑膜炎。
我们的结果表明，我们的技术在预防 FS 相关术后并发症方面是有效的。
