O'Connell Brendan P, Hunter Jacob B, Sweeney Alex D, Thompson Reid C, Chambless Lola B, Wanna George B, Rivas Alejandro
*Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee †Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas ‡Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee.
Otol Neurotol. 2017 Mar;38(3):416-422. doi: 10.1097/MAO.0000000000001321.
Describe the safety profile and surgical outcomes of a combined transmastoid-middle cranial fossa suture "pull-through" technique for repair of lateral skull base defects.
Retrospective.
Tertiary care hospital.
Patients undergoing surgery for cerebrospinal fluid (CSF) fistula and/or encephalocele.
Combined transmastoid and middle fossa approach using suture pull-through technique.
The primary outcome measures of interest were recurrence of CSF fistula or encephalocele, and postoperative air-bone gap.
Twenty-six patients were included; mean age at surgery was 60 ± 14 years and 65% of patients were female. The majority of defects involved both the tegmen mastoideum and tympani (69%); multiple defects were present in 11 patients. Small craniotomy (2 × 3 cm) was performed and defects were repaired using composite grafts constructed with fascia, bone, and/or cartilage, and dural substitute affixed with suture. The suture tail was left long and passed from the middle fossa through the defect into the mastoid. At average follow-up of 8.3 months, no patients of recurrent CSF leak were noted. Significant improvements in both mean pure-tone average and air-bone gap were noted for the entire cohort (p = 0.04 and p = 0.02, respectively).
A combined transmastoid-middle cranial fossa for the repair of lateral skull base CSF fistula and encephaloceles using the suture "pull-through" technique is efficacious and the complication profile is favorable. This method facilitates reliable placement of a composite graft in the center of lateral skull base defects through a small craniotomy that minimizes temporal lobe retraction.
描述联合经乳突-中颅窝缝线“牵拉”技术修复侧颅底缺损的安全性及手术效果。
回顾性研究。
三级医疗中心。
接受脑脊液（CSF）瘘和/或脑膨出手术的患者。
采用缝线牵拉技术的联合经乳突和中颅窝入路。
主要观察指标为脑脊液瘘或脑膨出的复发情况以及术后气骨导差。
纳入26例患者；手术时的平均年龄为60±14岁，65%的患者为女性。大多数缺损累及乳突盖和鼓室（69%）；11例患者存在多处缺损。进行了小骨窗开颅术（2×3 cm），使用由筋膜、骨和/或软骨构建的复合移植物以及用缝线固定的硬脑膜替代物修复缺损。缝线末端留长，从中颅窝穿过缺损进入乳突。平均随访8.3个月时，未发现患者脑脊液漏复发。整个队列的平均纯音听阈和气骨导差均有显著改善（分别为p = 0.04和p = 0.02）。
采用缝线“牵拉”技术的联合经乳突-中颅窝入路修复侧颅底脑脊液瘘和脑膨出有效，并发症情况良好。该方法通过小骨窗开颅术便于将复合移植物可靠地放置在侧颅底缺损中心，可最大程度减少颞叶牵拉。
