Ishii Yudo, Tahara Shigeyuki, Hattori Yujiro, Teramoto Akira, Morita Akio, Matsuno Akira
Department of Neurosurgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan,
Neurosurg Rev. 2015 Jul;38(3):551-6; discussion 556-7. doi: 10.1007/s10143-015-0614-6. Epub 2015 Feb 14.
With the development of endoscopic technology and surgery, resection of midline skull base tumors has been achieved using endoscopic endonasal skull base (EESB) approaches. EESB approaches reportedly have a greater risk of postoperative cerebrospinal fluid (CSF) leakage. Recently, the introduction of the nasoseptal flap (NSF) decreased dramatically the incidence of CSF leakage, but the use of an NSF increases the risk of disturbing the function of the nose. Here, we report our new technique called "fascia patchwork closure" for closure after EESB surgery and its outcome. All 48 cases involved midline skull base tumors resected via EESB approaches. Of them, 32 cases were closed by the fascia patchwork technique after tumor resection, and there was no incidence of CSF leakage. Moreover, 6 of the 32 cases were closed without the use of an NSF, indicating that the fascia patchwork closure approach is effective as part of a multilayer closure for the prevention of CSF leakage. The establishment and popularization of this technique might result in the further development of EESB surgery and also an improvement of postoperative nasal function.
随着内镜技术和手术的发展，经鼻内镜鼻颅底（EESB）入路已实现对中线颅底肿瘤的切除。据报道，EESB入路术后脑脊液（CSF）漏的风险更高。最近，鼻中隔瓣（NSF）的应用显著降低了CSF漏的发生率，但使用NSF会增加干扰鼻腔功能的风险。在此，我们报告我们的新技术“筋膜拼接缝合”用于EESB手术后的封闭及其效果。所有48例均为经EESB入路切除的中线颅底肿瘤。其中，32例在肿瘤切除后采用筋膜拼接技术封闭，未发生CSF漏。此外，32例中有6例未使用NSF进行封闭，这表明筋膜拼接缝合入路作为多层封闭的一部分对预防CSF漏是有效的。该技术的建立和推广可能会推动EESB手术的进一步发展，并改善术后鼻腔功能。
