Hayashi Nakamasa, Mitsuya Koichi, Gorai Katsuya, Inoue Keita, Ito Ichiro, Nakagawa Masahiro, Nakasu Yoko
Divisions of Neurosurgery, Plastic and Reconstructive Surgery, and Pathology, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
J Neurol Surg B Skull Base. 2015 Feb;76(1):7-11. doi: 10.1055/s-0034-1386655. Epub 2014 Aug 11.
Objectives Perifascial areolar tissue (PAT), a layer of loose connective tissue on the deep fascias with a rich vascular plexus, serves as a vital cover over defects with scarce vascularity. We report the usefulness of PAT as a nonvascularized alternative to flaps for reconstruction of dural defects in skull base surgery and transsphenoidal surgery while evaluating its effect on control of cerebrospinal fluid (CSF) leakage. Design A retrospective chart analysis was performed on patients who had undergone repair of a dural defect with PAT during skull base surgery or transsphenoidal surgery between December 2004 and October 2011. Results Twenty-one patients were included: 11 patients had received surgical treatment and/or irradiation. Fourteen of the 21 patients had pre- and/or intraoperative CSF leakage. Only one patient (4.8%) had postoperative CSF leakage requiring additional surgical repair. Ten patients underwent postoperative irradiation from 1 to 15 months after transplant of the PAT. None of the patients had postoperative CSF leakage after irradiation. Conclusion We successfully repaired dural defects using PAT in skull base surgery and transsphenoidal surgery, even in patients with a history of multiple operations and radiotherapy. PAT may serve as a valuable tool for skull base reconstruction.
筋膜周蜂窝组织（PAT）是深筋膜上一层具有丰富血管丛的疏松结缔组织，是血管稀少部位缺损的重要覆盖物。我们报告了PAT作为一种非血管化皮瓣替代物在颅底手术和经蝶窦手术中修复硬脑膜缺损的有效性，并评估了其对控制脑脊液（CSF）漏的作用。设计：对2004年12月至2011年10月期间在颅底手术或经蝶窦手术中使用PAT修复硬脑膜缺损的患者进行回顾性图表分析。结果：纳入21例患者，其中11例接受过手术治疗和/或放疗。21例患者中有14例存在术前和/或术中脑脊液漏。仅1例患者（4.8%）术后出现脑脊液漏，需要再次手术修复。10例患者在PAT移植后1至15个月接受了术后放疗。放疗后所有患者均未出现脑脊液漏。结论：我们在颅底手术和经蝶窦手术中使用PAT成功修复了硬脑膜缺损，即使是有多次手术和放疗史的患者。PAT可能是颅底重建的一种有价值的工具。
