Fathalla Hussein, Di Ieva Antonio, Lee John, Anderson Jennifer, Jing Rowan, Solarski Michael, Cusimano Michael D
Department of Surgery, Division of Neurosurgery, St. Michaels Hospital, University of Toronto, Toronto, ON, Canada.
Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B1W8s, Canada.
Neurosurg Rev. 2017 Apr;40(2):309-318. doi: 10.1007/s10143-016-0776-x. Epub 2016 Aug 24.
Following extended endoscopic transsphenoidal approach (EETSA), cerebrospinal fluid (CSF) leak rate has been reported in the range of 5-50 %. Novel closure techniques, such as the nasoseptal flap and other multilayered repairs improved the outcomes significantly but took most of our focus. Little attention, however, was given to other aspects of the equation such as nasal support-to support the heavy weight of such repairs-and lumbar drains. These are important because they diminish the forces acting on both sides of the repair, hence covering all the angles. We reviewed data of 98 consecutive patients who underwent an EETSA between 1999 and 2014. We analyzed the rates of CSF leak throughout the years and with every modification added to our closure technique. Common pathologies encountered were invasive adenomas, meningiomas, chordomas, and craniopharyngiomas. CSF leak occurred overall in five patients (5.1 %). The nasoseptal flap decreased the rate of CSF leak but not significantly (P = 0.112), while placing a nasal trumpet to support our repair resulted in significant decrease in CSF leak rate (P = 0.0013). In the last 2 years of our series, when all modifications took place and all angles were covered, there was one leak in 35 cases (2.8 %). A protocol that covers all the angles by a good multilayered repair (regardless of its type and materials) while diminishing the forces acting on both sides of the repair leads to a minimal rate of CSF leak. No principle alone is effective individually.
在采用扩大经蝶窦入路（EETSA）后，脑脊液（CSF）漏出率据报道在5%至50%之间。新型封闭技术，如鼻中隔瓣和其他多层修复方法显著改善了治疗效果，但占据了我们大部分的关注焦点。然而，对于该治疗方案的其他方面，如支撑此类修复物沉重重量的鼻腔支撑结构以及腰大池引流管，却很少有人关注。这些方面很重要，因为它们能减小作用于修复部位两侧的力，从而全面考虑到各个因素。我们回顾了1999年至2014年间连续接受EETSA治疗的98例患者的数据。我们分析了多年来以及每次对封闭技术进行改进后的脑脊液漏出率。常见的病变包括侵袭性腺瘤、脑膜瘤、脊索瘤和颅咽管瘤。总体上有5例患者（5.1%）发生了脑脊液漏。鼻中隔瓣降低了脑脊液漏出率，但差异不显著（P = 0.112），而放置鼻扩张器以支撑我们的修复操作则使脑脊液漏出率显著降低（P = 0.0013）。在我们研究系列的最后2年，当所有改进措施都实施且所有因素都得到考虑时，35例中有1例发生漏液（2.8%）。一个通过良好的多层修复（无论其类型和材料）全面考虑各个因素，同时减小作用于修复部位两侧力的方案，可使脑脊液漏出率降至最低。单独任何一个原则都不是有效的。
