Departments of Neurosurgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York 10065, USA.
J Neurosurg. 2013 Sep;119(3):661-8. doi: 10.3171/2013.4.JNS13124. Epub 2013 May 31.
Endoscopic transsphenoidal surgery is expanding in acceptance, yet postoperative CSF leak rates remain a concern. This study presents the Cornell closure protocol, which has yielded significantly lower postoperative CSF leak rates compared with prior reports, as an algorithm that can be used by centers having difficulty with CSF leak.
A single closure algorithm for endoscopic surgery has been used since January 2010 at Weill Cornell Medical College. A prospective database noting intraoperative CSF leak, closure technique, and postoperative CSF leak was reviewed. The authors used a MEDLINE search to identify similar studies and compared CSF leak rates to those of patients treated using the Cornell algorithm.
The retrospective study of a prospectively acquired database included 209 consecutive patients. In 84 patients (40%) there was no intraoperative CSF leak and no postoperative CSF leak. In the 125 patients (60%) with an intraoperative CSF leak, 35 of them with high-flow leaks, there were 0 (0%) postoperative CSF leaks.
It is possible to achieve a CSF leak rate of 0% by using this closure protocol. With proper experience, endoscopic skull base surgery should not be considered to have a higher CSF leak rate than open transcranial or microscopic transsphenoidal surgery.
经鼻内镜蝶窦手术的应用日益广泛，但术后脑脊液漏仍是一个令人关注的问题。本研究介绍了康奈尔闭合方案，与既往报道相比，该方案显著降低了术后脑脊液漏的发生率，为术后脑脊液漏处理困难的中心提供了一种可供选择的方案。
自 2010 年 1 月以来，我们在康奈尔大学医学中心一直使用单一的内镜手术闭合方案。我们回顾了一份记录术中脑脊液漏、闭合技术和术后脑脊液漏的前瞻性数据库。作者使用 MEDLINE 检索来确定类似的研究，并将脑脊液漏的发生率与采用康奈尔方案治疗的患者进行比较。
这项前瞻性数据库的回顾性研究纳入了 209 例连续患者。在 84 例（40%）患者中，无术中脑脊液漏，也无术后脑脊液漏。在 125 例（60%）术中存在脑脊液漏的患者中，其中 35 例为高流量漏，术后无一例发生脑脊液漏。
采用这种闭合方案，有可能使脑脊液漏的发生率降为 0%。有了适当的经验，内镜颅底手术不应被认为比开颅经颅或显微镜经蝶窦手术具有更高的脑脊液漏发生率。
