Xuejian Wang, Fan Hu, Xiaobiao Zhang, Yong Yu, Ye Gu, Tao Xie, Junqi Ge
Fudan University, Zhongshan Hospital, Department of Neurosurgery, Shanghai, China.
Turk Neurosurg. 2013;23(4):439-45. doi: 10.5137/1019-5149.JTN.6176-12.0.
Multilayer reconstruction of skull base using nasal pedicled mucosal flap has been widely accepted as a standard method for repairing high flow cerebrospinal fluid [CSF] leakage. In this study, we analyzed our outcome and summarized several valuable operation experiences from this technique.
This study included 20 consecutive patients who underwent endoscopic endonasal multilayer reconstruction using a nasal pedicled mucosal flap to repair high flow CSF leakage and were available for follow-up.
In this series, all cases encountered intraoperative high-flow CSF leakage, including 11 (55%) patients with opening of third ventricles (TV) and 9 (45%) patients with wide opening of cistern (CS). After endoscopic endonasal multilayer reconstruction with nasal pedicled mucosal flap, 3 patients (15.0%) encountered CSF leakage in the early postoperative period but were successfully repaired; 2 patients (10.0%) encountered late postoperative CSF leakage. In the TV group, the ratio of CSF leakage was 18.2% (2/11); while the incidence of CSF leakage was 11.1% (1/9) in the CS group. One patient developed meningitis due to CSF leakage four month after surgery, then gave up treatment and died.
Multilayer reconstruction with nasal pedicled flap seems to be useful and reliable for the treatment of ventral skull base defects using endoscopic endonasal approach.
采用带蒂鼻黏膜瓣对颅底进行多层重建已被广泛接受为修复高流量脑脊液漏的标准方法。在本研究中，我们分析了治疗结果并总结了该技术的一些宝贵手术经验。
本研究纳入了连续20例接受内镜下经鼻带蒂鼻黏膜瓣多层重建修复高流量脑脊液漏且可供随访的患者。
在该系列中，所有病例术中均出现高流量脑脊液漏，其中11例（55%）患者第三脑室开放，9例（45%）患者脑池广泛开放。经内镜下经鼻带蒂鼻黏膜瓣多层重建后，3例患者（15.0%）术后早期出现脑脊液漏，但均成功修复；2例患者（10.0%）术后出现晚期脑脊液漏。在第三脑室开放组中，脑脊液漏发生率为18.2%（2/11）；而脑池广泛开放组脑脊液漏发生率为11.1%（1/9）。1例患者术后4个月因脑脊液漏并发脑膜炎，后放弃治疗死亡。
带蒂鼻黏膜瓣多层重建对于采用内镜下经鼻入路治疗腹侧颅底缺损似乎是有效且可靠的。
