Gill Kurren S, Hsu David, Tassone Patrick, Pluta John, Nyquist Gurston, Krein Howard, Bilyk Jurij, Murchison Ann P, Iloreta Alfred, Evans James J, Heffelfinger Ryan N, Curry Joseph M
Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.
Laryngoscope. 2017 Apr;127(4):835-841. doi: 10.1002/lary.26137. Epub 2016 Sep 7.
To assess risk factors for cerebrospinal fluid (CSF) leak and complications after microvascular reconstruction of cranio-orbitofacial resection with orbital exenteration (CFOE).
Retrospective case series.
Seventy consecutive patients at a tertiary hospital underwent 76 procedures with microvascular reconstruction of CFOE defects. Patients were stratified by extent of skull base exposure and presence or absence of dural resection. Patients with exposure of the orbital apex and roof alone were classified as minimal skull base exposure (MS) (n = 32). Those with skull base exposure beyond the orbital apex and roof were classified as significant skull base exposure (SS) (n = 38) and were subdivided into those with dural exposure (SSe) (n = 15) and those with dural resection (SSr) (n = 23). The main outcome measure was incidence of postoperative CSF leak according to univariate and multivariate analysis of risk factors, including previous radiation, surgery, and location of defect.
Intraoperative leaks occurred in five and four patients in the MS and SSe groups, respectively, with no postoperative leaks. In the SSr group, five patients developed a postoperative CSF leak and three required operative management. Multivariate analysis revealed middle fossa exposure to be the only significant predictor of CSF leak (P = 0.03). The overall complication rate was 31.6%. Major complications were greater in the SS group compared to the MS group (P = 0.05).
In this series, middle fossa resection increased the risk of postoperative CSF leak after microvascular reconstruction of CFOE defects, and complication rates were greater with more complex defects.
评估颅眶面切除联合眶内容剜除术（CFOE）微血管重建术后脑脊液（CSF）漏及并发症的危险因素。
回顾性病例系列研究。
一家三级医院的70例连续患者接受了76例CFOE缺损微血管重建手术。根据颅底暴露程度和硬脑膜切除情况对患者进行分层。仅眶尖和眶顶暴露的患者被分类为最小颅底暴露（MS）组（n = 32）。颅底暴露超出眶尖和眶顶的患者被分类为显著颅底暴露（SS）组（n = 38），并进一步细分为硬脑膜暴露组（SSe）（n = 15）和硬脑膜切除组（SSr）（n = 23）。主要观察指标是根据危险因素的单因素和多因素分析得出的术后脑脊液漏发生率，包括既往放疗、手术及缺损部位。
MS组和SSe组分别有5例和4例患者术中出现脑脊液漏，术后均无脑脊液漏。SSr组有5例患者发生术后脑脊液漏，3例需要手术处理。多因素分析显示中颅窝暴露是脑脊液漏的唯一显著预测因素（P = 0.03）。总体并发症发生率为31.6%。SS组的主要并发症发生率高于MS组（P = 0.05）。
在本系列研究中，中颅窝切除增加了CFOE缺损微血管重建术后脑脊液漏的风险，缺损越复杂，并发症发生率越高。
4。《喉镜》，2017年，第127卷，第835 - 841页
