Peris-Celda Maria, Chaskes Mark, Lee Daniel D, Kenning Tyler J, Pinheiro-Neto Carlos D
Department of Neurosurgery, Albany Medical Center, Albany, New York, USA.
Albany Medical College, Albany, New York, USA.
World Neurosurg. 2017 May;101:180-185. doi: 10.1016/j.wneu.2017.01.102. Epub 2017 Feb 7.
Postoperative cerebrospinal fluid leak after endoscopic pituitary surgery ranges from 1.9% to 10% in different series. Vascularized flaps have reduced the incidence of leak; however, this carries nasal morbidity. This study presents a technique for sellar reconstruction with free mucosal graft from the nasal cavity floor including inferior meatus mucosa. This technique aims to standardize sellar reconstruction without the use of the nasoseptal flap and to keep the advantage of mucosal coverage of the defect in all cases.
Fifty consecutive patients who had endoscopic surgery for pituitary tumors and reconstruction with nasal cavity floor free mucosal graft were retrospectively reviewed. There were a total of 50 patients with postoperative follow-up from 3 to 16 months. Collagen dural graft was used inlay and free mucosal graft overlay to cover the sellar defect. No fat grafts or lumbar drains were used. A Sinonasal Outcome Test-22 (SNOT-22) was performed before, 1 and 3 months after surgery.
There were 40% detected intraoperative leaks and no postoperative leaks. Nasal endoscopy performed at 1 month follow-up showed complete healing of the graft to the skull base and near total or complete mucosalization of the donor site. No significant difference was found in the SNOT-22 comparing the total preoperative and 1-month scores.
The nasal cavity floor free mucosal graft is an easy and safe technique, with minimal nasal morbidity. There were no postoperative cerebrospinal fluid leaks, despite aggressive tumor resection. No lumbar drains or fat graft were used. The harvest of mucosal graft does not worsen the quality of life measured with the SNOT-22 test.
在内镜下垂体手术中，术后脑脊液漏在不同系列报道中的发生率为1.9%至10%。带血管蒂皮瓣降低了漏液的发生率；然而，这会带来鼻腔相关并发症。本研究介绍了一种使用来自鼻腔底部包括下鼻道黏膜的游离黏膜移植物进行鞍区重建的技术。该技术旨在规范鞍区重建，不使用鼻中隔皮瓣，并在所有情况下保持对缺损进行黏膜覆盖的优势。
回顾性分析连续50例行垂体肿瘤内镜手术并采用鼻腔底部游离黏膜移植物重建的患者。共有50例患者术后随访3至16个月。使用胶原硬脑膜移植物镶嵌和游离黏膜移植物覆盖来封闭鞍区缺损。未使用脂肪移植物或腰大池引流。在手术前、术后1个月和3个月进行鼻窦结局测试-22（SNOT-22）。
术中发现40%的患者有脑脊液漏，但术后无漏液。术后1个月的鼻内镜检查显示移植物与颅底完全愈合，供区近乎完全或完全黏膜化。术前总分与术后1个月的SNOT-22评分相比无显著差异。
鼻腔底部游离黏膜移植物是一种简单安全的技术，鼻腔并发症极少。尽管肿瘤切除范围较大，但术后无脑脊液漏。未使用腰大池引流或脂肪移植物。黏膜移植物的获取并未使通过SNOT-22测试评估的生活质量恶化。
