Hadley M N, Martin N A, Spetzler R F, Sonntag V K, Johnson P C
Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona.
Neurosurgery. 1988 Feb;22(2):392-7. doi: 10.1227/00006123-198802000-00021.
A watertight dural closure is difficult to achieve after transoral-transclival operation for ventral intradural lesions at the craniocervical junction. These procedures have a high morbidity and mortality from cerebrospinal fluid (CSF) fistula, meningitis, and abscess. We used a canine model to test three different techniques of dural closure after transoral intradural operation: primary suture closure, laser patch weld, and fibrin glue patch closures. The primary suture closure technique was inadequate. All eight leaked CSF at the time of operation, and five had radiographic leaks and were incompetent at autopsy. All seven of the laser closures leaked CSF at operation, yet only one was incompetent at autopsy. The fibrin glue technique was superior and provided a solid seal at operation, even with repeated Valsalva maneuvers to 40 mm Hg. The immediate and persistent seal at operation is clinically significant because it may prevent CSF leak, meningitis, and abscess formation in human patients after transoral surgery. Fibrin glue is excellent for repairing complex dural defects and merits evaluation in clinical trials.
经口-经斜坡手术治疗颅颈交界区腹侧硬膜内病变后，很难实现硬膜的水密性缝合。这些手术因脑脊液（CSF）漏、脑膜炎和脓肿而具有较高的发病率和死亡率。我们使用犬模型来测试经口硬膜内手术后三种不同的硬膜缝合技术：一期缝合关闭、激光补片焊接和纤维蛋白胶补片关闭。一期缝合关闭技术并不充分。所有8只在手术时均有脑脊液漏，5只在影像学上有漏液，尸检时发现其缝合处无效。所有7只接受激光封闭的犬在手术时均有脑脊液漏，但尸检时只有1只缝合处无效。纤维蛋白胶技术更优越，即使反复进行高达40 mmHg的瓦尔萨尔瓦动作，在手术时也能提供牢固的封闭。手术时即刻和持久的封闭具有临床意义，因为它可能预防人类患者经口手术后出现脑脊液漏、脑膜炎和脓肿形成。纤维蛋白胶在修复复杂的硬膜缺损方面表现出色，值得在临床试验中进行评估。
