Stanford University School of Medicine, Stanford, California, USA.
Otolaryngol Head Neck Surg. 2014 May;150(5):730-8. doi: 10.1177/0194599814520685. Epub 2014 Feb 3.
To systematically review the literature concerning techniques of closure of endoscopically created skull base defects based on site of skull base defect and flow rate of cerebrospinal fluid (CSF).
PubMed, SCOPUS, and Cochrane databases.
A comprehensive systematic literature review.
The literature search produced a total of 1708 studies. Of these, 1585 studies were excluded based on title and/or abstract review. A total of 123 articles remained for full-text review, 101 of which were subsequently excluded primarily because of lack of detailed information as to the reconstructive techniques used or clinical outcomes. Of the 22 studies remaining for final analysis, all were case series. A total of 673 patients were included in the analysis, with an overall postoperative CSF leak rate of 8.5%. Subgroup analysis was performed based on location of the skull base defect and presence and quality of intraoperative CSF leak.
Based on level 4 evidence, in cases of low-flow intraoperative CSF leaks, skull base reconstruction with multilayered free grafts and synthetic materials offers similar outcomes to vascularized flaps. In cases of high-flow intraoperative CSF leaks, pedicled vascularized flaps appear to be superior. Location of the defect does not seem to be a significant factor in determining successful closure, with the exception of clival defects. In all other sites, good closure may be achieved by multiple reconstructive approaches. More consistency in data reporting and higher levels of evidence will ultimately be necessary to make definitive recommendations.
系统回顾内镜下颅底缺陷闭合技术的文献，根据颅底缺陷的位置和脑脊液（CSF）流速进行分类。
PubMed、SCOPUS 和 Cochrane 数据库。
全面的系统文献回顾。
文献检索共产生了 1708 项研究。其中，根据标题和/或摘要评审排除了 1585 项研究。共有 123 篇文章进行了全文审查，其中 101 篇主要由于缺乏有关重建技术使用或临床结果的详细信息而被排除在外。在最终分析中，22 项研究中有 22 项研究，均为病例系列研究。共有 673 名患者纳入分析，术后总体 CSF 漏发生率为 8.5%。根据颅底缺陷的位置以及术中 CSF 漏的存在和质量进行了亚组分析。
基于 4 级证据，对于低流量术中 CSF 漏的病例，使用多层游离移植物和合成材料进行颅底重建与血管化皮瓣的结果相似。对于高流量术中 CSF 漏的病例，带蒂血管化皮瓣似乎更具优势。缺陷的位置似乎不是决定闭合成功的重要因素，但鞍区缺陷除外。在所有其他部位，通过多种重建方法可能实现良好的闭合。最终需要更一致的数据报告和更高水平的证据，才能提出明确的建议。
