Gruss Calvin L, Al Komser Mohammed, Aghi Manish K, Pletcher Steven D, Goldberg Andrew N, McDermott Michael, El-Sayed Ivan H
School of Medicine, Vanderbilt University, Nashville, Tennessee, USA Department of Otolaryngology-Head and Neck Surgery, University of California at San Francisco, San Francisco, California, USA
Department of Otolaryngology-Head and Neck Surgery, University of California at San Francisco, San Francisco, California, USA.
Otolaryngol Head Neck Surg. 2014 Sep;151(3):516-21. doi: 10.1177/0194599814536688. Epub 2014 Jun 4.
The use of expanded endonasal surgery (EES) in the treatment of skull base neoplasms has increased significantly in recent years. Since 2006, the nasoseptal flap (NSF) has become the workhorse for the closure of skull base defects involving the anterior and central skull base. We hypothesized that defect site impacts the rate of cerebrospinal fluid (CSF) leak following EES.
Retrospective cohort study.
SETTING/SUBJECTS/METHODS: Patients who underwent skull base defect repair using a NSF at the University of California at San Francisco (UCSF) minimally invasive skull base center were retrospectively reviewed. Patient demographics, disease, and defect location and size were recorded along with the presence of a postoperative CSF leak. Data were analyzed using Fisher's exact test.
One hundred and twenty-one patients met inclusion criteria. Ten patients had a NSF failure with CSF leakage, 2 in the anterior skull base (frontal sinus, ethmoid, cribriform, planum), and 8 in the central skull base (sella, clivus) (P = .047). Dural defect size ≥2.0 cm(2) in the central skull base strongly correlated with the risk of flap failure (P = .034).
This study of endoscopic closure of skull base defects using a NSF demonstrates there is an association between both surgical site and dural defect size with NSF failure. Expanded defects of the sella and clivus have an increased risk of failure and may warrant augmented techniques.
近年来，扩大经鼻手术（EES）在颅底肿瘤治疗中的应用显著增加。自2006年以来，鼻中隔瓣（NSF）已成为闭合涉及前颅底和中颅底的颅底缺损的主要手段。我们推测缺损部位会影响EES术后脑脊液（CSF）漏的发生率。
回顾性队列研究。
设置/研究对象/方法：对在加利福尼亚大学旧金山分校（UCSF）微创颅底中心接受NSF修复颅底缺损的患者进行回顾性研究。记录患者的人口统计学信息、疾病情况、缺损位置和大小以及术后CSF漏的情况。采用Fisher精确检验对数据进行分析。
121例患者符合纳入标准。10例患者NSF失败并伴有CSF漏，其中2例位于前颅底（额窦、筛窦、筛板、蝶骨平台），8例位于中颅底（蝶鞍、斜坡）（P = 0.047）。中颅底硬脑膜缺损大小≥2.0 cm²与瓣失败风险密切相关（P = 0.034）。
这项关于使用NSF内镜闭合颅底缺损的研究表明，手术部位和硬脑膜缺损大小与NSF失败之间均存在关联。蝶鞍和斜坡的扩大缺损失败风险增加，可能需要采用增强技术。
